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Sample records for patient transfer

  1. Transfer Out Patient Not Abandon The Patient

    Directory of Open Access Journals (Sweden)

    Deepak Gupta

    2015-12-01

    does not encompass part of deserting patients but rather appropriate transferring of patient care to accepting/receptive fellow brethren/colleagues. The transfer of care does not mean that a particular physician has failed to perform his/her duties for his/her patients rather that the particular relationship with a particular patient has failed to meet its ends. Therefore without abandoning the patient, the patient is given ample and honest opportunity to be transferred out to another physician with the sincere hope that the discharged patient will be able to achieve relief of his/her suffering with the new physician-patient relationship meeting their goals and means-to-the-ends. The one thing that need not be forgotten is that the terminated physician-patient relationship can always be revived if the causative concerns have been resolved in the interim and if the medico-legal laws and ethical practices allow the relationships’ revival. In summary, it is prerogative of the patient (whose suffering made him/her to reach out to a physician and enter in a physician-patient relationship in the first place when he/she wants to and decides to terminate physician-patient relationship; whereas the prerogative of the physician is to recognize a dysfunctional physician-patient relationship early-on so that corrective measures (if possible can be executed, and if that is not possible, then instead of patient abandonment, patients may be appropriately and timely transferred out off failed physician-patient relationship.

  2. Transference in the nurse-patient relationship.

    Science.gov (United States)

    Evans, A M

    2007-04-01

    The therapeutic relationship has been considered foundational to psychiatric nursing practice since at least the mid-20th century. However, this does not, in itself, guarantee either its continuity or relevance to current practice. Concepts such as the therapeutic relationship require sustained attention, both in theory and in practice, to illustrate ongoing relevance to the discipline. This paper addresses the therapeutic relationship in psychiatric nursing via aspects of psychoanalytic theory, particularly the notion of transference, as theorized by both Freud and Lacan. Two case fragments provide practice material, through which transference in the nurse-patient relationship is explored. The nurse, in the context of his/her relationship with the patient, a sick stranger, offers both a listening and the potential development of transference. This transference can be experienced, in part, as a form of attachment to the nurse, one that is not regarded pejoratively as dependency. There is the potential, within the nurse-patient relationship, for a psychical holding to develop, one from within which both the patient can speak and transference might arise. It is argued that listening to the patient has the potential to assist the patient and, with the development of transference, can provide the context for important work.

  3. Patient transfers and risk of back injury

    DEFF Research Database (Denmark)

    Vinstrup, Jonas; Madeleine, Pascal; Jakobsen, Markus Due

    2017-01-01

    in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree...... which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks. OBJECTIVE: The main objectives of this study are (1) to quantify low back and neck/shoulder muscle load....... The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers...

  4. Concept Generation Process for Patient Transferring Device

    Science.gov (United States)

    Dandavate, A. L.; Sarje, S. H.

    2012-07-01

    In this paper, an attempt has been made to develop concepts for patient transferring tasks. The concept generation process of patient transferring device (PTD), which includes interviews of the customers, interpretation of the needs, organizing the needs into a hierarchy, establishing relative importance of the needs, establishing target specifications, and conceptualization has been discussed in this paper. The authors conducted the interviews of customers at Mobilink NGO, St. John's Hospital, Bangalore in order to know the needs and wants for the PTD. AHP technique was used for establishing and evaluating relative importance of needs, and based on the importance of the customer needs, concepts were developed through brainstorming.

  5. Electronic transfer of sensitive patient data.

    Science.gov (United States)

    Detterbeck, A M W; Kaiser, J; Hirschfelder, U

    2015-01-01

    The purpose of this study was to develop decision-making aids and recommendations for dental practitioners regarding the utilization and sharing of sensitive digital patient data. In the current environment of growing digitization, healthcare professionals need detailed knowledge of secure data management to maximize confidentiality and minimize the risks involved in both archiving patient data and sharing it through electronic channels. Despite well-defined legal requirements, an all-inclusive technological solution does not currently exist. The need for a preliminary review and critical appraisal of common practices of data transfer prompted a search of the literature and the Web to identify viable methods of secure data exchange and to develop a flowchart. A strong focus was placed on the transmission of datasets both smaller than and larger than 10 MB, and on secure communication by smartphone. Although encryption of patient-related data should be routine, it is often difficult to implement. Pretty Good Privacy (PGP) and Secure/Multipurpose Internet Mail Extensions (S/MIME) are viable standards for secure e-mail encryption. Sharing of high-volume data should be accomplished with the help of file encryption. Careful handling of sensitive patient data is mandatory, and it is the end-user's responsibility to meet any requirements for encryption, preferably by using free, open-source (and hence transparent) software.

  6. Transfer of patients--from the spoke to the hub.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    We describe the nature, frequency, and characteristics of transfers to a regional centre. This was a three month prospective descriptive study of all transfers into the hospital through the ED and a further sample survey of 100 patients received into the resuscitation room over a 2 year period. 105 patient transfers were surveyed over the three month period. A significant number (43 patients) arrived at the ED without prior notification being received by ED staff, a proportion (7 patients) warranting resuscitation room assessment. The rate of Doctor Transfer was 22%. Of the 23 patients that warranted assessment in the resuscitation room 10 were unaccompanied by a Doctor and 5 were unaccompanied by either a Doctor or a Nurse. 11% of transfers had no transfer letter or radiographs. Only 51% of transferred patients had an IV line in situ. 4 out of the 8 transfers into the resuscitation room performed by interns were associated with adverse events. There continues to be problems with the quality of care that these patients receive. Clinicians must be actively involved in the development of regional transfer protocols and interfacility agreements to ensure the safe transfer of patients to definitive care.

  7. The elderly patient with spinal injury: treat or transfer?

    Science.gov (United States)

    Barmparas, Galinos; Cooper, Zara; Haider, Adil H; Havens, Joaquim M; Askari, Reza; Salim, Ali

    2016-05-01

    The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P spinal cord injury (22.3% versus 21.0%, P elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. INTERFACILITY TRANSFER OF PATIENTS IN SOUTH AFRICA ...

    African Journals Online (AJOL)

    Enrique

    Many people have medical aids to cover ... ment by appropriate transport teams so that the patient's level of care constantly increases. Central to ... that one must keep in mind and when there is ..... who had low concentrations of the hormone.

  9. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    Science.gov (United States)

    Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

    2012-01-01

    Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (Pkaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

  10. Doctor-Patient Knowledge Transfer: Innovative Technologies and Policy Implications

    OpenAIRE

    Sára, Zoltán; Csedő, Zoltán; Tóth, Tamás; Fejes, József; Pörzse, Gábor

    2013-01-01

    The aim of this study was to empirically investigate the barriers in doctor-patient communication and knowledge transfer and the role of innovative technologies in overcoming these barriers. We applied qualitative research methods. Our results show that patients extensively use information sources, primarily the Internet before the visits. Patients regularly apply a self-diagnosis regarding their diseases. This implies several risks as many of them are not able to properly inte...

  11. A proactive transfer policy for critical patient flow management.

    Science.gov (United States)

    González, Jaime; Ferrer, Juan-Carlos; Cataldo, Alejandro; Rojas, Luis

    2018-02-17

    Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy. Due to the high dimensionality of the optimization problem involved, an approximate dynamic programming approach is used to derive an approximation of the optimal decision policy, which indicates that a certain number of beds should be kept free in the different units as a function of the next period demand estimate. Testing the model on two instances of different sizes demonstrates that the optimal number of patient transfers between units changes when the emergency patient arrival rate for transfer to other units changes at a single unit, but remains stable if the change is proportionally the same for all units. In a simulation using real data for a hospital in Chile, significant improvements are achieved by the model in key emergency department performance indicators such as patient wait times (reduction higher than 50%), patient capacity (21% increase) and queue abandonment (from 7% down to less than 1%).

  12. Impact of Using a Robot Patient for Nursing Skill Training in Patient Transfer

    Science.gov (United States)

    Huang, Zhifeng; Lin, Chingszu; Kanai-Pak, Masako; Maeda, Jukai; Kitajima, Yasuko; Nakamura, Mitsuhiro; Kuwahara, Noriaki; Ogata, Taiki; Ota, Jun

    2017-01-01

    In the past few decades, simulation training has been used to help nurses improve their patient-transfer skills. However, the effectiveness of such training remains limited because it lacks effective ways of simulating patients' actions realistically. It is difficult for nurses to use the skills learned from simulation training to transfer an…

  13. Online Learning of Safe Patient Transfers in Occupational Therapy Education

    Directory of Open Access Journals (Sweden)

    Cynthia L. Hayden D. H. Ed., OTR/L, CHT

    2013-02-01

    Full Text Available Online higher education is steadily increasing. For programs in allied health to be offered effectively in an elearning format, clinical psychomotor skills need to be addressed. The aim of this research was to design, implement, and evaluate an online safe patient transfers module for occupational therapy assistant (OTAstudents. The efficacy of teaching safe patient transfers in an e-learning environment was appraised using both quantitative and qualitative analysis. The applied research project was completed at a Tennessee community college. A convenience sample of eighteen students participated in the pilot study. Twenty-five studentsparticipated in the subsequent study. The instructional design of the course was based on Mager’s CriterionReferenced Instruction model. Streaming video was used as the delivery method for course material. A pretest/posttest evaluated the students’ cognitive knowledge of safe patient transfers. A behavioral transferscompetency checklist was used to rate videotapes of students’ performance of assisted stand pivot and dependent sliding board transfers. Research findings indicated students were able to learn this psychomotor clinical skill online with beginning proficiency. A paired t-test showed marked improvement of cognitive knowledge. A student learning survey revealed the majority of students preferred at least one hands-on classroom session where instructor feedback and interaction with classmates confirmed safe and effectiveclinical technique.

  14. Using business intelligence for efficient inter-facility patient transfer.

    Science.gov (United States)

    Haque, Waqar; Derksen, Beth Ann; Calado, Devin; Foster, Lee

    2015-01-01

    In the context of inter-facility patient transfer, a transfer operator must be able to objectively identify a destination which meets the needs of a patient, while keeping in mind each facility's limitations. We propose a solution which uses Business Intelligence (BI) techniques to analyze data related to healthcare infrastructure and services, and provides a web based system to identify optimal destination(s). The proposed inter-facility transfer system uses a single data warehouse with an Online Analytical Processing (OLAP) cube built on top that supplies analytical data to multiple reports embedded in web pages. The data visualization tool includes map based navigation of the health authority as well as an interactive filtering mechanism which finds facilities meeting the selected criteria. The data visualization is backed by an intuitive data entry web form which safely constrains the data, ensuring consistency and a single version of truth. The overall time required to identify the destination for inter-facility transfers is reduced from hours to a few minutes with this interactive solution.

  15. Development and testing of emergency department patient transfer communication measures.

    Science.gov (United States)

    Klingner, Jill; Moscovice, Ira

    2012-01-01

    Communication problems are a major contributing factor to adverse events in hospitals.(1) The contextual environment in small rural hospitals increases the importance of emergency department (ED) patient transfer communication quality. This study addresses the communication problems through the development and testing of ED quality measurement of interfacility patient transfer communication. Input from existing measures, measurement and health care delivery experts, as well as hospital frontline staff was used to design and modify ED quality measures. Three field tests were conducted to determine the feasibility of data collection and the effectiveness of different training methods and types of partnerships. Measures were evaluated based on their prevalence, ease of data collection, and usefulness for internal and external improvement. It is feasible to collect ED quality measure data. Different data sources, data collection, and data entry methods, training and partners can be used to examine hospital ED quality. There is significant room for improvement in the communication of patient information between health care facilities. Current health care reform efforts highlight the importance of clear communication between organizations held accountable for patient safety and outcomes. The patient transfer communication measures have been tested in a wide range of rural settings and have been vetted nationally. They have been endorsed by the National Quality Forum, are included in the National Quality Measurement Clearinghouse supported by the Agency for Health Care Research and Quality (AHRQ), and are under consideration by the Centers for Medicare and Medicaid Services for future payment determinations beginning in calendar year 2013. © 2011 National Rural Health Association.

  16. Transfer of Patients in a Telestroke Network: What Are the Relevant Factors for Making This Decision?

    Science.gov (United States)

    Klingner, Carsten M; Brodoehl, Stefan; Funck, Laura; Klingner, Caroline C; Berrouschot, Jörg; Witte, Otto W; Günther, Albrecht

    2018-02-01

    Background/Introduction: Current telestroke network consultations are focused on decision-making in the hyperacute stage of stroke management. The two main questions in telestroke consultations are whether thrombolysis should be initiated and whether the patient should be transferred to a hub hospital. Although guidelines exist for initiating intravenous thrombolytic therapy, the question of whether patients should be transferred is far more elusive. In this study, we investigated the factors involved in the decision to transfer stroke patients to a hub hospital. We were particularly interested in identifying factors that promote or impede the transfer of patients. We enrolled 1,615 cases of telestroke consultation of the University Hospital Jena. The two main factors that independently influenced the probability of transferring a patient were the patient's age and the identification of a proximal vessel occlusion. Interestingly, factors such as the severity of symptoms and the time elapsed from symptom onset were not found to have an independent influence on the decision to transfer a patient. The transfer of most patients was justified by the possibility of performing interventional reperfusion therapy. We discuss the effectiveness of the current decision-making process and possible ways to improve decision-making for a more effective selection of patients who would benefit from transfer. The decision-making process to a transfer patient is not standardized and constitutes a trade-off between the intention to treat all possible patients while avoiding the transfer of patients without treatment options.

  17. What happens to patients on antiretroviral therapy who transfer out to another facility?

    Directory of Open Access Journals (Sweden)

    Joseph Kwong-Leung Yu

    Full Text Available BACKGROUND: Long term retention of patients on antiretroviral therapy (ART in Africa's rapidly expanding programmes is said to be 60% at 2 years. Many reports from African ART programmes make little mention of patients who are transferred out to another facility, yet Malawi's national figures show a transfer out of 9%. There is no published information about what happens to patients who transfer-out, but this is important because if they transfer-in and stay alive in these other facilities then national retention figures will be better than previously reported. METHODOLOGY/PRINCIPAL FINDINGS: Of all patients started on ART over a three year period in Mzuzu Central Hospital, North Region, Malawi, those who transferred out were identified from the ART register and master cards. Clinic staff attempted to trace these patients to determine whether they had transferred in to a new ART facility and their outcome status. There were 805 patients (19% of the total cohort who transferred out, of whom 737 (92% were traced as having transferred in to a new ART facility, with a median time of 1.3 months between transferring-out and transferring-in. Survival probability was superior and deaths were lower in the transfer-out patients compared with those who did not transfer. CONCLUSION/SIGNIFICANCE: In Mzuzu Central Hospital, patients who transfer-out constitute a large proportion of patients not retained on ART at their original clinic of registration. Good documentation of transfer-outs and transfer-ins are needed to keep track of national outcomes. Furthermore, the current practice of regarding transfer-outs as being double counted in national cohorts and subtracting this number from the total national registrations to get the number of new patients started on ART is correct.

  18. Trainees' perceptions of practitioner competence during patient transfer.

    Science.gov (United States)

    Grierson, Lawrence; Dubrowski, Adam; So, Steph; Kistner, Nicole; Carnahan, Heather

    2012-01-01

    Technical and communicative skills are both important features for one's perception of practitioner competence. This research examines how trainees' perceptions of practitioner competence change as they view health care practitioners who vary in their technical and communicative skill proficiencies. Occupational therapy students watched standardized encounters of a practitioner performing a patient transfer in combinations of low and high technical and communicative proficiency and then reported their perceptions of practitioner competence. The reports indicate that technical and communicative skills have independently identifiable impacts on the perceptions of practitioner competency, but technical proficiency has a special impact on the students' perceptions of practitioner communicative competence. The results are discussed with respect to the way in which students may evaluate their own competence on the basis of either technical or communicative skill. The issue of how this may lead trainees to dedicate their independent learning efforts to an incomplete set of features needed for the development of practitioner competency is raised.

  19. Transfer

    DEFF Research Database (Denmark)

    Wahlgren, Bjarne; Aarkrog, Vibe

    Bogen er den første samlede indføring i transfer på dansk. Transfer kan anvendes som praksis-filosofikum. Den giver en systematisk indsigt til den studerende, der spørger: Hvordan kan teoretisk viden bruges til at reflektere over handlinger i situationer, der passer til min fremtidige arbejdsplads?...

  20. Patient Perspectives on Gene Transfer Therapy for Sickle Cell Disease.

    Science.gov (United States)

    Strong, Heather; Mitchell, Monica J; Goldstein-Leever, Alana; Shook, Lisa; Malik, Punam; Crosby, Lori E

    2017-08-01

    Sickle cell disease (SCD) is a chronic genetic disease with high morbidity and early mortality; it affects nearly 100,000 individuals in the USA. Bone marrow transplantation, the only curative treatment, is available to less than 20% of patients because of a number of access barriers. Gene transfer therapy (GTT) has been shown to be curative in animal models and is approved for use in humans for early-phase studies at a few centers. GTT would offer a more accessible treatment option available to all patients. It is important to understand patient perspectives on GTT to help ensure human clinical trial success. Two focus groups were conducted with younger (18-30 years) and older (31 years and older) adults with SCD to obtain data on patient knowledge and beliefs about GTT. Data from these two focus groups was used to develop a GTT educational brochure. A third focus group was conducted to obtain participant feedback on acceptability and feasibility of education and the brochure. Most adults, especially young adults, had little knowledge about GTT and expressed fear and uncertainty about the side effects of chemotherapy (e.g., hair loss, infertility), use of a human immunodeficiency virus (HIV)-derived viral vector, and potential for cancer risk. Participants wanted full transparency in educational materials, but advised researchers not to share the vector's relation to HIV because of cultural stigma and no HIV virus is used for the GTT vector. Older adults had more desire to participate in human clinical GTT trials than younger participants. When recruiting for trials, researchers should develop GTT educational materials that address participant lack of trust in the healthcare system, cultural beliefs, fears related to side effects, and include visual illustrations. Use of such materials will provide adults with SCD the information they need to fully evaluate GTT.

  1. Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

    Science.gov (United States)

    Alamgir, Hasanat; Li, Olivia Wei; Yu, Shicheng; Gorman, Erin; Fast, Catherine; Kidd, Catherine

    2009-09-01

    Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

  2. COBRA 9121: Federal liability for patient screening and transfer.

    Science.gov (United States)

    Frew, S A

    1988-01-01

    Health care is no longer a simple cottage industry of individual providers. Increases in competition and government regulation have transformed the old structure of health care into a fend-for-yourself marketplace dominated by multi-institutional corporations. In order to accomplish this change, health care providers have had to alter their locus of attention from the patient to the bottom line. As a result, it is not surprising to find corporate business practices interspersed among the traditional health care practices. On March 1, 1987, the federal government began an assault on a casualty of this new market oriental philosophy, patient transfers or "dumping". COBRA 9121 is an "anti-dumping" law designed to prevent hospitals from continuing this practice. The vehicle for ensuring that the statute's broad provisions are followed is a set of "sudden death" probations. For example, under COBRA, hospitals found guilty of knowing or negligent violations may be suspended or terminated from receiving all Medicare reimbursement. One way to avoid these "sudden death" probations is to understand the implications of this law.

  3. Transferring skills in quality collaboratives focused on improving patient logistics.

    Science.gov (United States)

    Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen

    2018-04-02

    A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as 'important' in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Our findings seem to suggest that Quality collaboratives could benefit if more

  4. INTER-HOSPITAL TRANSFER OF TRAUMA PATIENTS IN A DEVELOPING COUNTRY: A PROSPECTIVE DESCRIPTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Vikas Verma

    2013-12-01

    Full Text Available Introduction: During interhospital transfer patients are at risk due to possibility of serious complications. There are no guidelines governing the transfer of injured patients in India. It is important to identify the extent of the problem in the transfer process of the injured transferred to the trauma centre.Methods: On arrival in the Emergency Department patients were assessed for clinical status and the Glasgow Coma Score (GCS. The transfer vehicle was evaluated and the accompanying transfer personnel was interviewed to record details of the transfer process, training of the transfer personnel, adequacy of the transfer vehicle and its outfitted monitoring equipment. Data communicated to the trauma centre from the referring hospitals were also collected from the transfer records. The transferred group was compared to the non-transferred group.Results: Of the 592 patients admitted, 572 consented to the study. 327 were referred patients and 245 were directly admitted patients. Patients referred from peripheral hospitals had significantly lower GCS, higher ISS, higher admission gap and longer duration of hospital stay. The date and time of injury was documented in none of the referred patients, referral time in 44 (13.71% cases, pulse rate in 110(34.38% patients, blood pressure in 112 (34.25% cases. The request for transfer was made in only 3 (0.93% cases. Twelve cases (3.66% were accompanied by a paramedic or a nurse. Intravenous access and infusions in progress were present in 192/327 (58.71% transferred patients. Urethral catheters were present in 49 (15.17% patients. Only 9/327 (2.79% transferred patients had hard cervical immobilization. Hypotension at admission defined as a systolic BP < 120mm of Hg was present in 106 referred admitted cases. Conclusion: This study suggests that the injured patients are not being transferred in a manner that is consistent with evidence based guidelines which are known to minimize the known hazards of

  5. TRANSFER

    African Journals Online (AJOL)

    This paper reports on further studies on long range energy transfer between curcumine as donor and another thiazine dye, thionine, which is closely related to methylene blue as energy harvester (Figure 1). Since thionine is known to have a higher quantum yield of singlet oxygen sensitization than methylene blue [8], it is ...

  6. Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes.

    Science.gov (United States)

    Holland, Christopher M; Lovasik, Brendan P; Howard, Brian M; McClure, Evan W; Samuels, Owen B; Barrow, Daniel L

    2017-09-01

    Interhospital transfer of neurosurgical patients is common; however, little is known about the impact of transfer parameters on clinical outcomes. Lower survival rates have been reported for patients admitted at night and on weekends in other specialties. Whether time or day of admission affects neurosurgical patient outcomes, specifically those transferred from other facilities, is unknown. To examine the impact of the timing of interhospital transfer on the hospital course and clinical outcomes of neurosurgical patients. All consecutive admissions of patients transferred to our adult neurosurgical service were retrospectively analyzed for a 1-year study period using data from a central transfer database and the electronic health record. Patients arrived more often at night (70.8%) despite an even distribution of transfer requests. The lack of transfer imaging did not affect length of stay, intervention times, or patient outcomes. Daytime arrivals had shorter total transfer time, but longer intenstive care unit and overall length of stay (8.7 and 11.6 days, respectively), worse modified Rankin Scale scores, lower rates of functional independence, and almost twice the mortality rate. Weekend admissions had significantly worse modified Rankin Scale scores and lower rates of functional independence. The timing of transfer arrivals, both by hour or day of the week, is correlated with the time to intervention, hospital course, and overall patient outcomes. Patients admitted during the weekend suffered worse functional outcomes and a trend towards increased mortality. While transfer logistics clearly impact patient outcomes, further work is needed to understand these complex relationships. Copyright © 2017 by the Congress of Neurological Surgeons.

  7. Decreased plasma cholesterol esterification and cholesteryl ester transfer in hypopituitary patients on glucocorticoid replacement therapy

    NARCIS (Netherlands)

    Beentjes, JAM; Van Tol, A; Sluiter, WJ; Dullaart, RPF

    Cardiovascular risk is increased in hypopituitary patients. No data are available with respect to the effect of glucocorticoid replacement therapy on high density lipoproteins (HDL) metabolism in such patients. Plasma lecithin:choresterol acyl transferase (LCAT), cholesteryl ester transfer protein

  8. Pediatric patients transferred for operative management of appendicitis: are they at a disadvantage?

    Science.gov (United States)

    Farach, Sandra M; Danielson, Paul D; Walford, N Elizabeth; Harmel, Richard P; Chandler, Nicole M

    2015-09-01

    Many pediatric patients are initially diagnosed with appendicitis at referring hospitals and are subsequently transferred to pediatric facilities. We aimed to compare outcomes of patients transferred to a pediatric referral center to those who present primarily for operative management of appendicitis. A retrospective review of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Demographic data, clinical parameters, and outcomes were analyzed. Transferred (n=222, 68%) and primary patients (n=104, 32%) were similar except for mean age (primary 12.4 vs. transferred 11.2 years, pprimary patients. Primary patients were more likely to present between the hours of 09:00 and 17:59 (52%), while transferred arrived equally across all hours. Both groups were more likely to present with acute appendicitis (primary 56% vs. transfer 61%, p=NS). There was no difference in time of diagnosis to time of appendectomy, length of hospital stay, or 30 day complications (primary 8.6% vs. transfer 5.8%, p=NS). Patients transferred for definitive care of appendicitis are not found to have more advanced disease or have increased complications; however, they are exposed to significantly more ionizing radiation during evaluation for appendicitis. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Using Six Sigma methodology to reduce patient transfer times from floor to critical-care beds.

    Science.gov (United States)

    Silich, Stephan J; Wetz, Robert V; Riebling, Nancy; Coleman, Christine; Khoueiry, Georges; Abi Rafeh, Nidal; Bagon, Emma; Szerszen, Anita

    2012-01-01

    In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. To test the efficacy of a Six Sigma intervention to reduce transfer time and establish a patient transfer process that would effectively enhance communication between hospital caregivers and improve the continuum of care for patients. The project was conducted at a 714-bed tertiary care hospital in Staten Island, New York. A Six Sigma multidisciplinary team was assembled to assess areas that needed improvement, manage the intervention, and analyze the results. The Six Sigma process identified eight key steps in the transfer of patients from general medical floors to critical care areas. Preintervention data and a root-cause analysis helped to establish the goal transfer-time limits of 3 h for any individual transfer and 90 min for the average of all transfers. The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex. © 2011 National Association for Healthcare Quality.

  10. Cost Savings Associated with the Adoption of a Cloud Computing Data Transfer System for Trauma Patients.

    Science.gov (United States)

    Feeney, James M; Montgomery, Stephanie C; Wolf, Laura; Jayaraman, Vijay; Twohig, Michael

    2016-09-01

    Among transferred trauma patients, challenges with the transfer of radiographic studies include problems loading or viewing the studies at the receiving hospitals, and problems manipulating, reconstructing, or evalu- ating the transferred images. Cloud-based image transfer systems may address some ofthese problems. We reviewed the charts of patients trans- ferred during one year surrounding the adoption of a cloud computing data transfer system. We compared the rates of repeat imaging before (precloud) and af- ter (postcloud) the adoption of the cloud-based data transfer system. During the precloud period, 28 out of 100 patients required 90 repeat studies. With the cloud computing transfer system in place, three out of 134 patients required seven repeat films. There was a statistically significant decrease in the proportion of patients requiring repeat films (28% to 2.2%, P < .0001). Based on an annualized volume of 200 trauma patient transfers, the cost savings estimated using three methods of cost analysis, is between $30,272 and $192,453.

  11. Nursing staff's communication modes in patient transfer before and after an educational intervention.

    Science.gov (United States)

    Kindblom-Rising, Kristina; Wahlstrom, Rolf; Ekman, Sirkka-Liisa; Buer, Nina; Nilsson-Wikmar, Lena

    2010-10-01

    The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. STATEMENT OF RELEVANCE: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.

  12. Patients' Preference for Number of Embryos Transferred During IVF ...

    African Journals Online (AJOL)

    Background: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries, with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro ...

  13. Safety analysis of patient transfers and handling tasks.

    Science.gov (United States)

    Vieira, Er; Kumar, S

    2009-10-01

    Low-back disorders are related to biomechanical demands, and nurses are among the professionals with the highest rates. Quantification of risk factors is important for safety assessment and reduction of low-back disorders. This study aimed to quantify physical demands of frequent nursing tasks and provide evidence-based recommendations to increase low-back safety. Thirty-six volunteer female nurses participated in a cross-sectional study of nine nursing tasks. Lumbar range of motion (ROM) and motion during nursing tasks were measured. Compression and shear forces at L5/S1, ligament strain and percentage of population without sufficient torso strength to perform 14 phases of nine nursing tasks were estimated. Peak flexions during trolley-to-bed, bed-to-chair and chair-to-bed transfers reached the maximum flexion ROM of the nurses. Average lumbar flexion during trolley-to-bed transfers was >50% of flexion ROM, being higher than during all other tasks. Mean (SD) compression at L5/S1 (4754 N (437 N)) and population without sufficient torso strength (37% (9%)) were highest during the pushing phase of bed-to-trolley transfers. Shear force (487 N (40 N)) and ligament strain (14% (5%)) were highest during the pulling phase of trolley-to-bed transfers. Nursing tasks impose high biomechanical demands on the lumbar spine. Excessive lumbar flexion and forces are critical aspects of manual transfers requiring most of the nurses' capabilities. Evidence-based recommendations to improve low-back safety in common nursing tasks were provided. Fitness to work, job modifications and training programs can now be designed and assessed based on the results.

  14. Autologous Fat Transfer in a Patient with Lupus Erythematosus Profundus

    Directory of Open Access Journals (Sweden)

    Jimi Yoon

    2012-10-01

    Full Text Available Lupus erythematosus profundus, a form of chronic cutaneous lupus erythematosus, is a rare inflammatory disease involving in the lower dermis and subcutaneous tissues. It primarily affects the head, proximal upper arms, trunk, thighs, and presents as firm nodules, 1 to 3 cm in diameter. The overlying skin often becomes attached to the subcutaneous nodules and is drawn inward to produce deep, saucerized depressions. We present a rare case of lupus erythematosus profundus treated with autologous fat transfer.

  15. Successful twin delivery following transmyometrial embryo transfer in a patient with a false uterine cavity.

    Science.gov (United States)

    Muñoz, Manuel; Galindo, Noemí; Pérez-Cano, Inmaculada; Cruz, María; García-Velasco, Juan Antonio

    2014-02-01

    A successful pregnancy is the greatest goal for reproductive medicine. The probability that pregnancy occurs during a cycle of assisted reproduction is a function of multiple factors, of which embryo transfer is one of the most critical steps in these treatments. This article reports a case of successful pregnancy and twin delivery by transmyometrial embryo transfer after IVF in a woman with a neocavity parallel to the uterine cavity, which prevented the transfer of embryos to the correct place. The patient first went to another fertility centre where embryo transfer was impossible to perform because the cervix could not be canalized. Subsequently in this study clinic, after considering the difficulty of inserting a catheter into the endometrial cavity, a trial transfer was performed, which discovered a false route parallel to endometrial cavity. Following a first cycle in which conventional transcervical embryo transfer was performed, a transmyometrial embryo transfer was carried out and the patient became pregnant with twins. In cases where transcervical embryo transfer is very difficult or impossible to perform, the value of transmyometrial transfer is self-evident. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Improving the safety of patient transfer from AMU using a written checklist.

    Science.gov (United States)

    Hindmarsh, D; Lees, L

    2012-01-01

    Unsafe patient transfers are one of the top reasons for incident reporting in hospitals. Criteria guiding safe transfer have been issued by the NHS Litigation Authority. To meet this standard, a "transfer check list" was redesigned for all patients leaving the Acute Medical Unit (AMU) in the Heartlands Hospital. Following the introduction of the checklist two full audit cycles were conducted. The first cycle highlighted an extremely poor uptake of the checklist. After interventions to educate nursing staff and raise awareness of the issues at the regular staff meetings, re-audit demonstrated significant improvement in completion rate. Subsequent monitoring indicates continued improvement, with compliance up to 95% for completion of the transfer checklist on AMU. Incident reporting relating to transfer has also decreased significantly.

  17. A taxonomy and cultural analysis of intra-hospital patient transfers.

    Science.gov (United States)

    Rosenberg, Alana; Campbell Britton, Meredith; Feder, Shelli; Minges, Karl; Hodshon, Beth; Chaudhry, Sarwat I; Jenq, Grace Y; Emerson, Beth L

    2018-05-02

    Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff. © 2018 Wiley Periodicals, Inc.

  18. Pregnancy derived from human zygote pronuclear transfer in a patient who had arrested embryos after IVF.

    Science.gov (United States)

    Zhang, John; Zhuang, Guanglun; Zeng, Yong; Grifo, Jamie; Acosta, Carlo; Shu, Yimin; Liu, Hui

    2016-10-01

    Nuclear transfer of an oocyte into the cytoplasm of another enucleated oocyte has shown that embryogenesis and implantation are influenced by cytoplasmic factors. We report a case of a 30-year-old nulligravida woman who had two failed IVF cycles characterized by all her embryos arresting at the two-cell stage and ultimately had pronuclear transfer using donor oocytes. After her third IVF cycle, eight out of 12 patient oocytes and 12 out of 15 donor oocytes were fertilized. The patient's pronuclei were transferred subzonally into an enucleated donor cytoplasm resulting in seven reconstructed zygotes. Five viable reconstructed embryos were transferred into the patient's uterus resulting in a triplet pregnancy with fetal heartbeats, normal karyotypes and nuclear genetic fingerprinting matching the mother's genetic fingerprinting. Fetal mitochondrial DNA profiles were identical to those from donor cytoplasm with no detection of patient's mitochondrial DNA. This report suggests that a potentially viable pregnancy with normal karyotype can be achieved through pronuclear transfer. Ongoing work to establish the efficacy and safety of pronuclear transfer will result in its use as an aid for human reproduction. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Transfer effects of a cognitive strategy training for stroke patients with apraxia

    NARCIS (Netherlands)

    Geusgens, C. A. V.; van Heugten, C. M.; Cooijmans, J. P. J.; Jolles, J.; van den Heuvel, W. J. A.

    2007-01-01

    The objective of this study was to evaluate transfer effects of cognitive strategy training for stroke patients with apraxia. During 8 weeks, 29 apraxic patients received cognitive strategy training to teach them how to perform activities of daily living (ADL) as independently as possible. ADL

  20. The effect of constructing versus solving virtual patient cases on transfer of learning

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Jepsen, Rikke M H G; Rasmussen, Maria B

    2016-01-01

    standardized patients representing cardiopulmonary cases. Performances on the transfer test were video-recorded and assessed by two blinded raters using the Reporter, Interpreter, Manager, Educator (RIME) framework. Thirty-nine participants completed the transfer test. The VP-construction group spent......The purpose of this study was to explore the effect of actively constructing virtual patient (VP) cases compared with solving VP cases on knowledge gains, skills transfer and time spent on cases. Forty-five fourth-year medical students were randomized to constructing (VP-construction, n = 23......) or solving (VP-solving, n = 22) four cardiopulmonary VP cases. Whereas the VP-solving group solved the cases, the VP-construction group only received the final diagnosis and had to complete the history, physical findings, and lab results. After a week, participants completed a transfer test involving two...

  1. Transferring skills in quality collaboratives focused on improving patient logistics

    NARCIS (Netherlands)

    J.W.M. Weggelaar-Jansen (Anne Marie); J.D.H. van Wijngaarden (Jeroen)

    2018-01-01

    textabstractA quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to

  2. Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity.

    Science.gov (United States)

    O'Neil, Amy M; Sadosty, Annie T; Pasupathy, Kalyan S; Russi, Christopher; Lohse, Christine M; Campbell, Ronna L

    2016-11-01

    An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation-may lead to more external transfers to find care. This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR). We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06]; P =0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60-3.40]; P< 0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P <0.001) were more likely to require transfer and travel farther to access care. Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and adults older than 65 years are more

  3. Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity

    Directory of Open Access Journals (Sweden)

    Amy M. O’Neil

    2016-11-01

    Full Text Available Introduction: An increasing number of behavioral health (BH patients are presenting to the emergency department (ED while BH resources continue to decline. This situation may lead to more external transfers to find care. Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR. Results: We identified 2,585 BH visits, of which 1,083 (41.9% resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5] required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours. The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles. In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06]; P=0.005. Children younger than 18 years (OR [95% CI], 2.34 [1.60- 3.40]; P<0.001 and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P<0.001 were more likely to require transfer and travel farther to access care. Conclusion: Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well

  4. Assessing written communication during interhospital transfers of emergency general surgery patients.

    Science.gov (United States)

    Harl, Felicity N R; Saucke, Megan C; Greenberg, Caprice C; Ingraham, Angela M

    2017-06-15

    Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Benefits of a transfer clinic in adolescent and young adult kidney transplant patients.

    Science.gov (United States)

    McQuillan, Rory F; Toulany, Alene; Kaufman, Miriam; Schiff, Jeffrey R

    2015-01-01

    Adolescent and young adult kidney transplant recipients have worse graft outcomes than older and younger age groups. Difficulties in the process of transition, defined as the purposeful, planned movement of adolescents with chronic health conditions from child to adult-centered health care systems, may contribute to this. Improving the process of transition may improve adherence post-transfer to adult care services. The purpose of this study is to investigate whether a kidney transplant transfer clinic for adolescent and young adult kidney transplant recipients transitioning from pediatric to adult care improves adherence post-transfer. We developed a joint kidney transplant transfer clinic between a pediatric kidney transplant program, adult kidney transplant program, and adolescent medicine at two academic health centers. The transfer clinic facilitated communication between the adult and pediatric transplant teams, a face-to-face meeting of the patient with the adult team, and a meeting with the adolescent medicine physician. We compared the outcomes of 16 kidney transplant recipients transferred before the clinic was established with 16 patients who attended the clinic. The primary outcome was a composite measure of non-adherence. Non-adherence was defined as either self-reported medication non-adherence or displaying two of the following three characteristics: non-attendance at clinic, non-attendance for blood work appointments, or undetectable calcineurin inhibitor levels within 1 year post-transfer. The two groups were similar at baseline, with non-adherence identified in 43.75 % of patients. Non-adherent behavior in the year post-transfer, which included missing clinic visits, missing regular blood tests, and undetectable calcineurin inhibitor levels, was significantly lower in the cohort which attended the transfer clinic (18.8 versus 62.5 %, p = 0.03). The median change in estimated glomerular filtration rate (eGFR) in the year following transfer

  6. Benefits of a Transfer Clinic in Adolescent and Young Adult Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    Rory F. McQuillan

    2015-12-01

    Full Text Available Background: Adolescent and young adult kidney transplant recipients have worse graft outcomes than older and younger age groups. Difficulties in the process of transition, defined as the purposeful, planned movement of adolescents with chronic health conditions from child to adult-centered health care systems, may contribute to this. Improving the process of transition may improve adherence post-transfer to adult care services. Objective: The purpose of this study is to investigate whether a kidney transplant transfer clinic for adolescent and young adult kidney transplant recipients transitioning from pediatric to adult care improves adherence post-transfer. Methods: We developed a joint kidney transplant transfer clinic between a pediatric kidney transplant program, adult kidney transplant program, and adolescent medicine at two academic health centers. The transfer clinic facilitated communication between the adult and pediatric transplant teams, a face-to-face meeting of the patient with the adult team, and a meeting with the adolescent medicine physician. We compared the outcomes of 16 kidney transplant recipients transferred before the clinic was established with 16 patients who attended the clinic. The primary outcome was a composite measure of non-adherence. Non-adherence was defined as either self-reported medication non-adherence or displaying two of the following three characteristics: non-attendance at clinic, non-attendance for blood work appointments, or undetectable calcineurin inhibitor levels within 1 year post-transfer. Results: The two groups were similar at baseline, with non-adherence identified in 43.75 % of patients. Non-adherent behavior in the year post-transfer, which included missing clinic visits, missing regular blood tests, and undetectable calcineurin inhibitor levels, was significantly lower in the cohort which attended the transfer clinic (18.8 versus 62.5 %, p = 0.03. The median change in estimated glomerular

  7. Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients.

    Science.gov (United States)

    Mohr, Nicholas M; Vakkalanka, J Priyanka; Harland, Karisa K; Bell, Amanda; Skow, Brian; Shane, Dan M; Ward, Marcia M

    2018-03-01

    Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.

  8. Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

    Science.gov (United States)

    Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C

    2006-01-01

    At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

  9. A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients.

    Science.gov (United States)

    Watson, Justin J J; Moren, Alexis; Diggs, Brian; Houser, Ben; Eastes, Lynn; Brand, Dawn; Bilyeu, Pamela; Schreiber, Martin; Kiraly, Laszlo

    2016-05-01

    Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital. A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes. Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05). Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Validation of the Provincial Transfer Authorization Centre database: a comprehensive database containing records of all inter-facility patient transfers in the province of Ontario

    Directory of Open Access Journals (Sweden)

    MacDonald Russell D

    2006-10-01

    Full Text Available Abstract Background The Provincial Transfer Authorization Centre (PTAC was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database. Methods A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables. Results Of the 100 randomly selected patient transfer records, 95 (95% of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0. Conclusion The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created

  11. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients.

    Science.gov (United States)

    Harish, Varun; Raymond, Andrew P; Issler, Andrea C; Lajevardi, Sepehr S; Chang, Ling-Yun; Maitz, Peter K M; Kennedy, Peter

    2015-02-01

    The purpose of this study was to compare burn size estimation between referring centres and Burn Units in adult patients transferred to Burn Units in Sydney, Australia. A review of all adults transferred to Burn Units in Sydney, Australia between January 2009 and August 2013 was performed. The TBSA estimated by the referring institution was compared with the TBSA measured at the Burns Unit. There were 698 adults transferred to a Burns Unit. Equivalent TBSA estimation between the referring hospital and Burns Unit occurred in 30% of patients. Overestimation occurred at a ratio exceeding 3:1 with respect to underestimation, with the difference between the referring institutions and Burns Unit estimation being statistically significant (Pburn-injured patients as well as in patients transferred more than 48h after the burn (Pburn (Pburns (≥20% TBSA) were found to have more satisfactory burn size estimations compared with less severe injuries (burn size assessment by referring centres. The systemic tendency for overestimation occurs throughout the entire TBSA spectrum, and persists with increasing time after the burn. Underestimation occurs less frequently but rises with increasing time after the burn and with increasing TBSA. Severe burns (≥20% TBSA) are more accurately estimated by the referring hospital. The inaccuracies in burn size assessment have the potential to result in suboptimal treatment and inappropriate referral to specialised Burn Units. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  12. Transfer of training effects in stroke patients with apraxia: an exploratory study.

    Science.gov (United States)

    Geusgens, Chantal; van Heugten, Caroline; Donkervoort, Mireille; van den Ende, Els; Jolles, Jelle; van den Heuvel, Wim

    2006-04-01

    The goal of the present study was to examine the transfer of the effects of cognitive strategy training for stroke patients with apraxia from trained to non-trained tasks. In strategy training, the occurrence of transfer is expected as the training programme is aimed, not at relearning specific tasks, but at teaching patients new ways to handle the problems resulting from the impairment. Exploratory analyses were conducted on data previously collected in a randomised controlled trial on the efficacy of the strategy training. A total of 113 left hemisphere stroke patients were randomly assigned to a strategy training group and a group receiving occupational therapy as usual. Assessment of apraxia, motor functioning and activities of daily living (ADL) took place at baseline, after an eight-week treatment period, and five months after baseline. The primary outcome measure consisted of standardised ADL observations of trained and non-trained tasks. The analyses showed that in both treatment groups, the scores on the ADL observations for non-trained tasks improved significantly after eight weeks of training as compared with the baseline score. Change scores of non-trained activities were larger in the strategy training group as compared with the usual treatment group. By using previously collected data we are able to illustrate the potential transfer of treatment effects in a large sample of stroke patients. We found indications for the occurrence of transfer, although the study was not originally designed for the purpose of evaluating transfer. Therefore these results are worth exploring more profoundly. We will further investigate our preliminary conclusions in a new prospective study which is specifically designed to examine the transfer of training effects.

  13. Transfer effects of a cognitive strategy training for stroke patients with apraxia.

    Science.gov (United States)

    Geusgens, C A V; van Heugten, C M; Cooijmans, J P J; Jolles, J; van den Heuvel, W J A

    2007-11-01

    The objective of this study was to evaluate transfer effects of cognitive strategy training for stroke patients with apraxia. During 8 weeks, 29 apraxic patients received cognitive strategy training to teach them how to perform activities of daily living (ADL) as independently as possible. ADL functioning was assessed at the rehabilitation centre at baseline and after 8 weeks of training. In addition, assessment took place at the patients' own homes after 8 weeks of training and 5 months after the start of the training. The performance of both trained and nontrained tasks was observed. Patients performed trained tasks and nontrained tasks at the same level of independency at the rehabilitation centre as well as at home, indicating transfer of training effects. These effects turned out to be stable over time.

  14. Self-Help Training System for Nursing Students to Learn Patient Transfer Skills

    Science.gov (United States)

    Huang, Zhifeng; Nagata, Ayanori; Kanai-Pak, Masako; Maeda, Jukai; Kitajima, Yasuko; Nakamura, Mitsuhiro; Aida, Kyoko; Kuwahara, Noriaki; Ogata, Taiki; Ota, Jun

    2014-01-01

    This paper describes the construction and evaluation of a self-help skill training system for assisting student nurses in learning skills involving the transfer of patients from beds to wheelchairs. We have proposed a feedback method that is based on a checklist and video demonstrations. To help trainees efficiently check their performance and…

  15. [Analysis of pregnancy outcomes of polycystic ovary syndrome patients after frozen embryo transfer].

    Science.gov (United States)

    Lyu, X D; Qiao, J

    2018-01-25

    Objective: To investigate pregnancy outcomes of the patients with polycystic ovary syndrome (PCOS) after frozen embryo transfer (FET) . Methods: Data of 2 367 PCOS patients received in vitro fertilization-embryo transfer [including fresh embryo transfer (fET) and FET] from January 2009 to December 2015 in Peking University Third Hospital were evaluated retrospectively. The basal characteristics, pregnancy complications and outcomes were analyzed, then identified the relative factors followed. Results: Totally 2 367 patients received in vitro fertilization-embryo transfer: 1 106 were treated with fET, and the rest 1 261 cases were treated with FET. The incidence of gestational diabetes mellitus (GDM) was lower in FET group [4.04%(51/1 261) versus 6.15%(68/1 106)], the difference was statistically significant ( Ppregnancy complications between the two groups (all P> 0.05). fET was an independent risk factor for GDM (adjusted OR= 1.570, 95% CI: 1.075-2.294). Conclusion: Compared with fET, FET could decrease the risk of GDM and receive better neonatal outcomes in patients with PCOS.

  16. Applications of aerospace technology in biomedicine. A technology transfer profile: Patient monitoring

    Science.gov (United States)

    Murray, D. M.

    1971-01-01

    NASA contributions to cardiovascular monitoring are described along with innovations in intracardiac blood pressure monitoring. A brief overview of the process of NASA technology transfer in patient monitoring is presented and a list of bioinstrumentation tech briefs and the number of requests for technical support is included.

  17. TRANSFERENCE BEFORE TRANSFERENCE.

    Science.gov (United States)

    Bonaminio, Vincenzo

    2017-10-01

    This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session. © 2017 The Psychoanalytic Quarterly, Inc.

  18. Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients

    DEFF Research Database (Denmark)

    Andersen, Dorthe; Løssl, Kristine; Nyboe Andersen, Anders

    2010-01-01

    This prospective, randomized, controlled and double-blinded trial studied whether acupuncture in relation to embryo transfer could increase the ongoing pregnancy rates and live birth rates in women undergoing assisted reproductive therapy. A total of 635 patients undergoing IVF or intracytoplasmic...... sperm injection (ICSI) were included. In 314 patients, embryo transfer was accompanied by acupuncture according to the principles of traditional Chinese medicine. In the control group, 321 patients received placebo acupuncture using a validated placebo needle. In the acupuncture group and the placebo...... group, the ongoing pregnancy rates were 27% (95% CI 22-32) and 32% (95% CI 27-37), respectively. Live birth rates were 25% (95% CI 20-30) in the acupuncture group and 30% (95% CI 25-30) in the placebo group. The differences were not statistically significant. These results suggest that acupuncture...

  19. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    Science.gov (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  20. Clinical outcome of fresh and vitrified-warmed blastocyst and cleavage-stage embryo transfers in ethnic Chinese ART patients

    Directory of Open Access Journals (Sweden)

    Tong Guo

    2012-10-01

    Full Text Available Abstract Objectives This study sought to evaluate the outcome of fresh and vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing ART treatment within an ethnic Chinese population. Study design We compared the clinical results of embryo transfer on the 3rd (cleavage stage or 5th (blastocyst stage day after oocyte retrieval, including clinical pregnancy rates, implantation rates and multiple pregnancy rates. Results Our data showed that blastocyst transfer on day 5 did not significantly increase clinical pregnancy rate (41.07% vs 47.08%, p>0.05 and implantation rate (31.8% vs 31.2%, p>0.05 in patients under 35 years of age, in comparison with day 3 cleavage stage embryo transfer. In patients older than 35 years of age, the clinical pregnancy rate after blastocyst transfer was slightly decreased compared with cleavage stage embryo transfer (33.33% vs 42.31%, p>0.05. Unexpectedly, It was found that vitrified-warmed blastocyst transfer resulted in significantly higher clinical pregnancy rate (56.8% and implantation rate (47% compared with fresh blastocyst transfer in controlled stimulation cycles (41.07% and 31.8%, respectively. For patients under 35 years of age, the cumulative clinical pregnancy rate combining fresh and vitrified-warmed blastocyst transfer cycles were significantly higher compared to just cleavage-stage embryo transfer (70.1% versus 51.8%, p Conclusions In an ethnic Chinese patient population, fresh blastocyst transfer does not significantly increase clinical pregnancy rate. However, subsequent vitrified-warmed blastocyst transfer in a non-controlled ovarian hyperstimulation cycle dramatically improves clinical outcomes. Therefore, blastocyst culture in tandem with vitrified-warmed blastocyst transfer is recommended as a favourable and promising protocol in human ART treatment, particularly for ethnic Chinese patients.

  1. Clinical outcome of fresh and vitrified-warmed blastocyst and cleavage-stage embryo transfers in ethnic Chinese ART patients.

    Science.gov (United States)

    Tong, Guo Qing; Cao, Shan Ren; Wu, Xun; Zhang, Jun Qiang; Cui, Ji; Heng, Boon Chin; Ling, Xiu Feng

    2012-10-05

    This study sought to evaluate the outcome of fresh and vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing ART treatment within an ethnic Chinese population. We compared the clinical results of embryo transfer on the 3rd (cleavage stage) or 5th (blastocyst stage) day after oocyte retrieval, including clinical pregnancy rates, implantation rates and multiple pregnancy rates. Our data showed that blastocyst transfer on day 5 did not significantly increase clinical pregnancy rate (41.07% vs 47.08%, p>0.05) and implantation rate (31.8% vs 31.2%, p>0.05) in patients under 35 years of age, in comparison with day 3 cleavage stage embryo transfer. In patients older than 35 years of age, the clinical pregnancy rate after blastocyst transfer was slightly decreased compared with cleavage stage embryo transfer (33.33% vs 42.31%, p>0.05). Unexpectedly, It was found that vitrified-warmed blastocyst transfer resulted in significantly higher clinical pregnancy rate (56.8%) and implantation rate (47%) compared with fresh blastocyst transfer in controlled stimulation cycles (41.07% and 31.8%, respectively). For patients under 35 years of age, the cumulative clinical pregnancy rate combining fresh and vitrified-warmed blastocyst transfer cycles were significantly higher compared to just cleavage-stage embryo transfer (70.1% versus 51.8%, p<0.05). However, the cumulative multiple pregnancy rates showed no significant difference between the two groups. In an ethnic Chinese patient population, fresh blastocyst transfer does not significantly increase clinical pregnancy rate. However, subsequent vitrified-warmed blastocyst transfer in a non-controlled ovarian hyperstimulation cycle dramatically improves clinical outcomes. Therefore, blastocyst culture in tandem with vitrified-warmed blastocyst transfer is recommended as a favourable and promising protocol in human ART treatment, particularly for ethnic Chinese patients.

  2. Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.

    Science.gov (United States)

    Ferree, Steven; van der Vliet, Quirine M J; Nawijn, Femke; Bhashyam, Abhiram R; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2018-03-01

    For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

    Science.gov (United States)

    Lin, Yanxia; Myall, Michelle; Jarrett, Nikki

    2017-12-01

    To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

  4. Predictors of complications when transferring postoperative cardiac patients from the intensive care unit

    Directory of Open Access Journals (Sweden)

    K. V. Paromov

    2017-11-01

    Full Text Available Aim. Emphasis in the study was placed on the evaluation of predictors of complications when transferring postoperative cardiac patients from the intensive care unit (ICU.Methods. 60 patients after cardiac surgery were included into this prospective observational study, with 41 of them undergoing off-pump coronary artery bypass grafting (CABG. Before the transfer from ICU, echocardiographical criteria of their systolic and diastolic dysfunction, parameters of oxygenation, hemodynamic and metabolism status, as well as postoperative complications and duration of hospitalization were evaluated. Results. Preoperatively, the patients had a moderate degree of heart failure and preserved ejection fraction. Those patients who had undergone valvular and combined procedures using cardiopulmonary bypass had higher Euroscore II values, more severe heart failure, prolonged duration of surgery, respiratory support and hospitalization in ICU and in hospital. The echocardiographical criteria of diastolic dysfunction before transfer from ICU were recorded in 14-77% patients. Despite a normal range of blood pressure, the systolic function of the left ventricle and preload (left atrial pressure, oxygenation and metabolic status, venous to arterial carbon dioxide difference (Pv-aCO2 and left ventricle performance index (Tei exceeded the normal values before transfer from ICU. The correlation analysis revealed a relationship between duration of ICU and hospital stay and the criteria of heart failure severity (left atrial pressure [rho = 0.27, 95% CI 0.02–0.48, p = 0.04] and left ventricle dysfunction (e’ [rho = 0.41, 95% CI 0.17–0.59, p<0.01] before the transfer. The increase in fluid balance during ICU stay after off-pump coronary artery bypass surgery tended to result in a complicated postoperative period (AUC = 0.73, p = 0.02 and a higher risk of atrial fibrillation.Conclusion. The impairment of the left ventricle diastolic function before transferring from

  5. Outcomes of microvascular free tissue transfer in twice-irradiated patients.

    Science.gov (United States)

    Clancy, Kate; Melki, Sami; Awan, Musaddiq; Li, Shawn; Lavertu, Pierre; Fowler, Nicole; Yao, Min; Rezaee, Rod; Zender, Chad A

    2017-09-01

    Patients may require microvascular free tissue transfer (MFTT) following re-irradiation for recurrent cancer or radiation complications. The objective of this study was to describe the indications for and outcomes of free flaps performed in twice-radiated patients. A retrospective chart review identified the indications for and outcomes of 36 free flaps performed on 29 twice-irradiated patients. The free flap success rate was 92%. The most common indications requiring MFTT were cancer recurrence and osteoradionecrosis. Sixty-one percent experienced postoperative complications, most commonly wound infection (33%). Twenty-five percent of the procedures required return to the operating room due to postoperative complication. MFTT can be successfully performed in the twice-irradiated patient population with a success rate comparable to singly-radiated patients. Despite a high success rate, there is also a high rate of surgical site complications, especially infection. © 2017 Wiley Periodicals, Inc.

  6. From cure to palliation: staff communication, documentation, and transfer of patient.

    Science.gov (United States)

    Löfmark, Rurik; Nilstun, Tore; Bolmsjö, Ingrid Agren

    2005-12-01

    In the transition from curative treatment to palliative care of a general end-of-life patient population, the internal communication of the acute care staff seems to be less than optimal. The communication had reference to the dialogue within the staff both before and after the decision to concentrate on palliative care, and possible transfer of the patient. This survey of Swedish nurses and physicians showed that most of 780 respondents wanted more internal communication, and a more individualized procedure of decision-making. All staff should be informed about the decision made but full agreement was not seen as realistic. The largest difference of opinion between nurses and physicians concerned the involvement of nurses in the decision-making about the transition. A uniform documentation of the decision to transfer care focus was the ideal. Approximately every fourth patient in acute care is transferred to receive palliative care. Only approximately half of the respondents had any training in palliative care and the majority wanted more training. There seems to be a need for more palliative care training, perhaps somewhat different for each specialty. Furthermore, a common language to enable nurses and physicians to communicate more easily may improve the transition process.

  7. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers.

    Science.gov (United States)

    Dunn, Adam G; Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-05-01

    To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols.

  8. A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.

    Science.gov (United States)

    Hall, Michael; Robertson, Jamie; Merkel, Matthias; Aziz, Michael; Hutchens, Michael

    2017-08-01

    Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. We hypothesized that a collaborative, comprehensive, structured handover of care from the intraoperative team to the ICU team would reduce a specific set of postoperative complications. We tested this hypothesis by developing and introducing a comprehensive multidisciplinary transfer of care process. We measured patient outcomes before and after the intervention using a linkage between 2 care databases: an Anesthesia Information Management System and a critical care complication registry database. There were 1127 total postoperative cardiac surgery admissions during the study period, 550 before and 577 after the intervention. There was no statistical difference between overall complications before and after the intervention (P = .154). However, there was a statistically significant reduction in preventable complications after the intervention (P = .023). The main finding of this investigation is that the introduction of a collaborative, comprehensive transfer of care process from the operating room to the ICU was associated with patients suffering fewer preventable complications.

  9. The study of diagnosis status and, transfer time of stroke patients transferred by pre-hospital emergency medical system (EMS to Vali-Asr hospital in Arak City

    Directory of Open Access Journals (Sweden)

    Saiedeh Bahrampouri

    2013-08-01

    Full Text Available Introduction: Stroke is main cause of death and disability in worldwide and emergency care can decrease complications. Emergency Medical System transferred half of stroke patients to hospital, so improve accuracy of diagnosis may accelerated treatment. This study aimed to determine diagnosis status and, transfer time of stroke patients transferred by prehospital Emergency Medical System to hospital in Arak City. Methods: This study was descriptive -analytic study and all 43 patient’s records with a diagnosis of stroke that transferred by Emergency Medical System to hospital in Arak City was selected. The study Checklist was contained information about age, sex, type of accident prehospital, response time, scene time, transfer time and total time from inpatients records and Emergency Center statistics .Regarding data analysis,SPSS19 software and descriptive statistical tests were used. Results: Mean (SD of age all patients were 73/7±3/8 and 51/2% were women. Ambulance paramedics' stroke diagnosis was correct in 15 (34/9%,20(46/5%of false and 8(18/6% not diagnosed for stroke patients who initially presented to them. The most common non stroke conditions were confusion. Mean response time and scene time, transfer time and total time were 6/9,16/9,9/1 and 35/3 minutes, respectively. In patients with correct diagnose stroke, mean response, scene, transfer and total time were 7,17/1,3/9 and 35/7 minutes. The people with the wrong diagnosis or no diagnosis of stroke by emergency medical personnel were taken to hospital, Mean response, scene, transfer and total time were 6/9, 16/8,9/7 and 33/5 minutes. Conclusions: The results of this study showed that, the correct diagnosis by EMS personnel could be resulted faster transferring patient to definite treatment center.It is recommended to develop prehospital diagnosis tool of stroke, which is contextually adapted and appropriate to facilitate diagnose of strokes and improve the quality of care.

  10. Atrophy and magnetization transfer ratio of the corpus callosum in patients with Alzheimer's disease

    International Nuclear Information System (INIS)

    Imon, Yukari; Hanyu, Haruo; Iwamoto, Toshihiko; Takasaki, Masaru; Abe, Kimihiko

    1998-01-01

    We compared atrophy and magnetization transfer ratio (MTR) in the corpus callosum in patients with Alzheimer's disease and age-matched normal subjects. Fifteen patients with Alzheimer's disease and fourteen normal subjects received MRI. The corpus callosum was divided into three parts (anterior, middle, and posterior portions) on midsagittal slice, and their areas on T2-weighted reversed images and MTR on magnetization transfer contrast images in each portion were measured. The area and MTR decreased significantly in the posterior portion in patients with Alzheimer's disease. In the anterior portion, MTR decreased significantly, but although the area showed no significant change. In the middle portion, the area and MTR showed no significant change. MTR and the area was correlated in each portion in patients with Alzheimer's disease. The score of Hasegawa dementia scale-revised (HDS-R) and the area of the middle, posterior and total of corpus callosum were significantly related. The score of HDS-R and MTR in the anterior portion of corpus callosum were significantly related. The present study revealed decreases in MTR in the anterior portion of the corpus callosum of patients with Alzheimer's disease although the area showed no significant change, and this change suggests the increase in free water and/or the decrease in bound water in tissues, probably due to demyelination and axonal degeneration. (author)

  11. Perceived barriers to communication between hospital and nursing home at time of patient transfer.

    Science.gov (United States)

    Shah, Faraaz; Burack, Orah; Boockvar, Kenneth S

    2010-05-01

    To identify perceived barriers to communication between hospital and nursing home at the time of patient transfer and examine associations between perceived barriers and hospital and nursing home characteristics. Mailed survey. Medicare- or Medicaid-certified nursing homes in New York State. Nursing home administrators, with input from other nursing home staff. Respondents rated the importance as a barrier to hospital-nursing home communication of (1) hospital providers' attitude, time, effort, training, payment, and familiarity with nursing home patients; (2) unplanned and off-hours transfers; (3) HIPAA privacy regulations; and (4) lost or failed information transmission. Associations were determined between barriers and the following organizational characteristics: (1) hospital-nursing home affiliations, pharmacy or laboratory agreements, cross-site staff visits, and cross-site physician care; (2) hospital size, teaching status, and frequency of geriatrics specialty care; (3) nursing home size, location, type, staffing, and Medicare quality indicators; and (4) hospital-to-nursing home communication, consistency of hospital care with health care goals, and communication quality improvement efforts. Of 647 questionnaires sent, 229 were returned (35.4%). The most frequently reported perceived barriers to communication were sudden or unplanned transfers (44.4%), transfers that occur at night or on the weekend (41.4%), and hospital providers' lack of effort (51.0%), lack of familiarity with patients (45.0%), and lack of time (43.5%). Increased hospital size, teaching hospitals, and urban nursing home location were associated with greater perceived importance of these barriers, and cross-site staff visits and hospital provision of laboratory and pharmacy services to the nursing home were associated with lower perceived importance of these barriers. Hospital and nursing home characteristics and interorganizational relationships were associated with nursing home

  12. Turning Over Patient Turnover: An Ethnographic Study of Admissions, Discharges, and Transfers

    Science.gov (United States)

    Mowinski Jennings, Bonnie; Sandelowski, Margarete; Boshamer, Cary C.; Higgins, Melinda K.

    2014-01-01

    The impact on nursing work of patient turnover (admissions, discharges, and transfers) became evident in an ethnographic study of turbulence. The patient turnover data were generated from extensive observations, 21 formal interviews, and a year of admission and discharge records on one medical and one surgical unit. Timing of turnover events on the two units differed, but on both units admissions typically interrupted workflow more than did discharges, clustered admissions were more disruptive than staggered admissions, and patient turnover during change of shift was more disruptive than during medication administration. Understanding the complexity of patient turnover will elucidate the work involved and improve the evidence base for nurse staffing, a key determinant of quality and safety of care. PMID:24242196

  13. Recovery of forward stepping in spinal cord injured patients does not transfer to untrained backward stepping.

    Science.gov (United States)

    Grasso, Renato; Ivanenko, Yuri P; Zago, Myrka; Molinari, Marco; Scivoletto, Giorgio; Lacquaniti, Francesco

    2004-08-01

    Six spinal cord injured (SCI) patients were trained to step on a treadmill with body-weight support for 1.5-3 months. At the end of training, foot motion recovered the shape and the step-by-step reproducibility that characterize normal gait. They were then asked to step backward on the treadmill belt that moved in the opposite direction relative to standard forward training. In contrast to healthy subjects, who can immediately reverse the direction of walking by time-reversing the kinematic waveforms, patients were unable to step backward. Similarly patients were unable to perform another untrained locomotor task, namely stepping in place on the idle treadmill. Two patients who were trained to step backward for 2-3 weeks were able to develop control of foot motion appropriate for this task. The results show that locomotor improvement does not transfer to untrained tasks, thus supporting the idea of task-dependent plasticity in human locomotor networks.

  14. A technique for transferring a patient's smile line to a cone beam computed tomography (CBCT) image.

    Science.gov (United States)

    Bidra, Avinash S

    2014-08-01

    Fixed implant-supported prosthodontic treatment for patients requiring a gingival prosthesis often demands that bone and implant levels be apical to the patient's maximum smile line. This is to avoid the display of the prosthesis-tissue junction (the junction between the gingival prosthesis and natural soft tissues) and prevent esthetic failures. Recording a patient's lip position during maximum smile is invaluable for the treatment planning process. This article presents a simple technique for clinically recording and transferring the patient's maximum smile line to cone beam computed tomography (CBCT) images for analysis. The technique can help clinicians accurately determine the need for and amount of bone reduction required with respect to the maximum smile line and place implants in optimal positions. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  15. Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

    International Nuclear Information System (INIS)

    Haneya, Assad; Philipp, Alois; Foltan, Maik; Camboni, Daniele; Rupprecht, Leopold; Puehler, Thomas; Hirt, Stephan; Hilker, Michael; Kobuch, Reinhard; Schmid, Christof; Arlt, Matthias; Mueller, Thomas

    2009-01-01

    Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation. From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4. All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO. Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care. (author)

  16. Comparison of Healthcare Workers Transferring Patients Using Either Conventional Or Robotic Wheelchairs: Kinematic, Electromyographic, and Electrocardiographic Analyses

    Directory of Open Access Journals (Sweden)

    Hiromi Matsumoto

    2016-01-01

    Full Text Available Objectives. The aim of this study was to compare the musculoskeletal and physical strain on healthcare workers, by measuring range of motion (ROM, muscle activity, and heart rate (HR, during transfer of a simulated patient using either a robotic wheelchair (RWC or a conventional wheelchair (CWC. Methods. The subjects were 10 females who had work experience in transferring patients and another female adult as the simulated patient to be transferred from bed to a RWC or a CWC. In both experimental conditions, ROM, muscle activity, and HR were assessed in the subjects using motion sensors, electromyography, and electrocardiograms. Results. Peak ROM of shoulder flexion during assistive transfer with the RWC was significantly lower than that with the CWC. Values for back muscle activity during transfer were lower with the RWC than with the CWC. Conclusions. The findings suggest that the RWC may decrease workplace injuries and lower back pain in healthcare workers.

  17. Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers

    International Nuclear Information System (INIS)

    Duncan, M.J.; Manktelow, R.T.; Zuker, R.M.; Rosen, I.B.

    1985-01-01

    This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft

  18. Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, M.J.; Manktelow, R.T.; Zuker, R.M.; Rosen, I.B.

    1985-12-01

    This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft.

  19. Transfer of copper from a chelated 67Cu-antibody conjugate to ceruloplasmin in lymphoma patients

    International Nuclear Information System (INIS)

    Mirick, Gary R.; O'Donnell, Robert T.; DeNardo, Sally J.; Shen Sui; Meares, Claude F.; DeNardo, Gerald L.

    1999-01-01

    The Lym-1 monoclonal antibody was conjugated with the bifunctional chelating agent 6-[p-(bromoacetamido)benzyl]-1,4,8,11-tetraazacyclotetradecane-N,N',N'',N' -tetraacetic acid (BAT), using 2IT as a linker, and radiolabeled with 67 Cu to make the radiopharmaceutical, 67 Cu-2IT-BAT-Lym-1. Ten patients received a total of 18 doses of 67 Cu-2IT-BAT-Lym-1 as targeted, systemic radiotherapy. The beta phase of blood clearance, when corrected for 67 Cu decay, was positive or flat, a phenomenon not observed in similar patients treated with 131 I-Lym-1. The flat beta phase of blood clearance suggested recycling of 67 Cu from 67 Cu-2IT-BAT-Lym-1 to another plasma protein. Therefore, the amount of 67 Cu transferred from the radiopharmaceutical to CP, Alb, and TF was measured using affinity-purified polyclonal antibodies. The fraction of plasma 67 Cu precipitated by anti-human CP increased daily; most blood radioactivity was 67 Cu-CP after a median of 4 days (range 2-7 days). The transfer of 67 Cu to CP was observed in all patients and was consistent from dose to dose within the same patient. An average of 2.8±1.5% (range 0.8-7.8%) of the 67 Cu dose (%ID) was transferred to CP. The release rate of 67 Cu-CP from the liver into the blood was 0.9±0.4 %ID/day for the first 3 days. The 67 Cu-CP effective clearance half-life was 3.7 ± 0.7 days. Subtraction of the 67 Cu-CP activity from the total blood radioactivity yielded a biphasic blood clearance similar to that obtained for patients given 131 I-Lym-1. Cu-67-CP increased the AUC for whole blood by 24 ± 10%. The %ID of 67 Cu recycled correlated with GGT, ALT, and alkaline phosphatase levels; r=0.958 (p 67 Cu-2IT-BAT-Lym-1 and recycles a small fraction of the 67 Cu, transferring it to CP

  20. Manual patient transfers used most often by student and staff nurses are consistent with their perceptions of transfer training, and performance confidence.

    Science.gov (United States)

    van Wyk, Paula M; Weir, Patricia L; Andrews, David M

    2015-01-01

    A disconnect in manual patient transfer (MPT) training practices for nurses, between what is taught and used in academic and clinical settings, could have implications for injury. This study aimed to determine: 1. what MPTs student and staff nurses use in clinical settings, and 2. if the MPTs used most often were also the ones they perceived that they received training for and had the most confidence performing. Survey responses from student nurses (n=163) (mid-sized university) and staff nurses (n=33) (local hospital) regarding 19 MPTs were analyzed to determine which transfers were perceived to be used most often, and which ones they had received training for and had the greatest confidence performing. The MPTs nurses perceived using most often were the same transfers they had the greatest confidence performing and for which they perceived receiving training. However, these MPTs were not taught at the university at the time of this investigation. Reducing the disconnect between manual patient transfer training obtained in the academic and clinical environments will hopefully reduce the risk of injury for nurses and improve the quality of care for patients.

  1. Patient Transfers and Risk of Back Injury: Protocol for a Prospective Cohort Study With Technical Measurements of Exposure.

    Science.gov (United States)

    Vinstrup, Jonas; Madeleine, Pascal; Jakobsen, Markus Due; Jay, Kenneth; Andersen, Lars Louis

    2017-11-08

    More than one third of nurses experience musculoskeletal pain several times during a normal work week. Consistent use of assistive devices during patient transfers is associated with a lower risk of occupational back injuries and low back pain (LBP). While uncertainties exist regarding which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks. The main objectives of this study are (1) to quantify low back and neck/shoulder muscle load in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree of back inclination and frequency) on LBP intensity and risk of back injury during a patient transfer. A combination of technical measurements (n=50) and a prospective study design (n=2000) will be applied on a cohort of female nurses in Danish hospitals. The technical measurements will be comprised of surface electromyography and accelerometers, with the aim of quantifying muscle load and body positions during various patient transfers, including different types of assistive devices throughout a workday. The study will thereby gather measurements during real-life working conditions. The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers. The objective measurements on muscle load and body positions during patient handlings will be applied to the fortnightly replies regarding frequency of patient transfer and use of different assistive devices, in

  2. A simulation framework for mapping risks in clinical processes: the case of in-patient transfers

    Science.gov (United States)

    Ong, Mei-Sing; Westbrook, Johanna I; Magrabi, Farah; Coiera, Enrico; Wobcke, Wayne

    2011-01-01

    Objective To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework. Design An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations. The model was calibrated using data from 101 patient transfers observed in a hospital and results were validated for one of two scenarios (a misidentification scenario and an infection control scenario). Repeated simulations using the calibrated model were undertaken to create a distribution of possible process outcomes. The likelihood of end-of-chain risk is the main outcome measure, reported for each of the two scenarios. Results The simulations demonstrate end-of-chain risks of 8% and 24% for the misidentification and infection control scenarios, respectively. Over 95% of the simulations in both scenarios are unique, indicating that the in-patient transfer process diverges from prescribed work practices in a variety of ways. Conclusions The simulation allowed us to model the risk of adverse events in a clinical process, by generating the variety of possible work subject to violations, a novel prospective risk analysis method. The in-patient transfer process has a high proportion of unique trajectories, implying that risk mitigation may benefit from focusing on reducing complexity rather than augmenting the process with further rule-based protocols. PMID:21486883

  3. Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients

    DEFF Research Database (Denmark)

    Andersen, Dorota; Løssl, Kristine; Nyboe Andersen, Anders

    2010-01-01

    group, the ongoing pregnancy rates were 27% (95% CI 22-32) and 32% (95% CI 27-37), respectively. Live birth rates were 25% (95% CI 20-30) in the acupuncture group and 30% (95% CI 25-30) in the placebo group. The differences were not statistically significant. These results suggest that acupuncture......This prospective, randomized, controlled and double-blinded trial studied whether acupuncture in relation to embryo transfer could increase the ongoing pregnancy rates and live birth rates in women undergoing assisted reproductive therapy. A total of 635 patients undergoing IVF or intracytoplasmic...

  4. Lost productivity in four European countries among patients with rheumatic disorders: are absenteeism and presenteeism transferable?

    Science.gov (United States)

    Knies, Saskia; Candel, Math J J M; Boonen, Annelies; Evers, Silvia M A A; Ament, Andre J H A; Severens, Johan L

    2012-09-01

    When national pharmacoeconomic guidelines are compared, different recommendations are identified on how to identify, measure and value lost productivity, leading to difficulties when comparing lost productivity estimates across countries. From a transferability point of view, the question arises of whether differences between countries regarding lost productivity are the result of using different calculation methods (methodological differences) or of other between-country differences. When lost productivity data differ significantly across countries, the transferability of lost productivity data across countries is hindered. The objective of this study was to investigate whether country of residence has a significant influence on the quantity of lost productivity among patients with rheumatic disorders. Confounding factors that might differ between countries were corrected for, while the methodology used to identify and measure lost productivity was kept the same. This question was investigated by means of an online questionnaire filled out by 200 respondents with a rheumatic disorder per country in four European countries, namely the Netherlands, the UK, Germany and France. In addition to those regarding lost productivity, the questionnaire contained questions about patient characteristics, disability insurance, disease characteristics, quality of life and job characteristics as these variables are expected to influence lost productivity in terms of absenteeism and presenteeism. The data were analysed by regression analyses, in which different components - being absent in last 3 months, number of days absent and presenteeism - of lost productivity were the main outcome measures and other variables, such as gender, impact of disease, shift work, job control, partial disability and overall general health, were corrected for. The results showed that country sometimes has a significant influence on lost productivity and that other variables such as, for example, age

  5. Benzodiazepines II: Waking Up on Sedatives: Providing Optimal Care When Inheriting Benzodiazepine Prescriptions in Transfer Patients

    Directory of Open Access Journals (Sweden)

    Jeffrey Guina

    2018-01-01

    Full Text Available This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision—sometimes mutually agreed-upon and sometimes unilateral—to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes, comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e.g., monitoring symptoms, laboratory testing, prescribing contracts, state prescription databases, stages of change and discontinuation (e.g., tapering, psychotherapeutic interventions, education, handouts, reassurance, medications to assist with discontinuation, and alternative treatments.

  6. Nuclear overhauser enhancement mediated chemical exchange saturation transfer imaging at 7 Tesla in glioblastoma patients.

    Directory of Open Access Journals (Sweden)

    Daniel Paech

    Full Text Available BACKGROUND AND PURPOSE: Nuclear Overhauser Enhancement (NOE mediated chemical exchange saturation transfer (CEST is a novel magnetic resonance imaging (MRI technique on the basis of saturation transfer between exchanging protons of tissue proteins and bulk water. The purpose of this study was to evaluate and compare the information provided by three dimensional NOE mediated CEST at 7 Tesla (7T and standard MRI in glioblastoma patients. PATIENTS AND METHODS: Twelve patients with newly diagnosed histologically proven glioblastoma were enrolled in this prospective ethics committee-approved study. NOE mediated CEST contrast was acquired with a modified three-dimensional gradient-echo sequence and asymmetry analysis was conducted at 3.3 ppm (B1 = 0.7 µT to calculate the magnetization transfer ratio asymmetry (MTR(asym. Contrast enhanced T1 (CE-T1 and T2-weighted images were acquired at 3T and used for data co-registration and comparison. RESULTS: Mean NOE mediated CEST signal based on MTR(asym values over all patients was significantly increased (p<0.001 in CE-T1 tumor (-1.99 ± 1.22%, tumor necrosis (-1.36 ± 1.30% and peritumoral CEST hyperintensities (PTCH within T2 edema margins (-3.56 ± 1.24% compared to contralateral normal appearing white matter (-8.38 ± 1.19%. In CE-T1 tumor (p = 0.015 and tumor necrosis (p<0.001 mean MTR(asym values were significantly higher than in PTCH. Extent of the surrounding tumor hyperintensity was smaller in eight out of 12 patients on CEST than on T2-weighted images, while four displayed at equal size. In all patients, isolated high intensity regions (0.40 ± 2.21% displayed on CEST within the CE-T1 tumor that were not discernible on CE-T1 or T2-weighted images. CONCLUSION: NOE mediated CEST Imaging at 7 T provides additional information on the structure of peritumoral hyperintensities in glioblastoma and displays isolated high intensity regions within the CE-T1 tumor that cannot be acquired on CE-T1 or T2

  7. Magnetization transfer imaging of periventricular white matter lesions in patients with multi-infarct dementia

    International Nuclear Information System (INIS)

    Hanyu, Haruo; Imon, Yukari; Asano, Tetsuichi; Iwamoto, Toshihiko; Takasaki, Masaru

    1998-01-01

    Using magnetization transfer (MT) imaging, we studied the underlying pathological conditions of periventricular hyperintense (PVH) white matter changes seen on T2-weighted MR images of patients with multi-infarct dementia. Twenty-two patients with multiple lacunar infarcts and PVH lesions, including 11 with dementia (diagnosed as multi-infarct dementia) and 11 without dementia, and 10 control subjects (with multiple lacunes, but no PVH lesion) were studied using the MT technique. MT ratios (MTRs) were calculated for PVH lesions (normal-appearing frontal white matter in controls) and the genu of the corpus callosum. Signal intensities on T2-weighted images in PVH lesions of patients were significantly higher than those in normal-appearing white matter of controls, while there were no significant differences in signal intensity in the genu of the corpus callosum among the dementia, non-dementia and control groups. However, MTRs in patients with PVH lesions were significantly lower than those in controls, and MTRs in demented patients were significantly lower than those in non-demented patients. Moreover, MTRs in the genu of the corpus callosum of demented patients were significantly lower than in those in non-demented patients and controls. MTRs in PVH lesions and the genu of the corpus callosum significantly correlated with Hasegawa's dementia scale score. These results suggest that there is some difference in histopathologic changes of PVH lesions between demented and non-demented patients and that the pathological substrate in the corpus callosum may play a role in inducing cognitive decline. Studies with MT imaging may allow the characterization of different pathological conditions that cannot be visualized by conventional MRI. (author)

  8. Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.

    Science.gov (United States)

    Veinot, Tiffany C; Bosk, Emily A; Unnikrishnan, K P; Iwashyna, Theodore J

    2012-11-01

    Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U.S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the U.S. are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of U.S. national Medicare records for 1996-2006. Community hospitals in the U.S., including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a "usual" transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. Copyright © 2012 Elsevier Ltd

  9. Towards single embryo transfer? Modelling clinical outcomes of potential treatment choices using multiple data sources: predictive models and patient perspectives.

    Science.gov (United States)

    Roberts, Sa; McGowan, L; Hirst, Wm; Brison, Dr; Vail, A; Lieberman, Ba

    2010-07-01

    In vitro fertilisation (IVF) treatments involve an egg retrieval process, fertilisation and culture of the resultant embryos in the laboratory, and the transfer of embryos back to the mother over one or more transfer cycles. The first transfer is usually of fresh embryos and the remainder may be cryopreserved for future frozen cycles. Most commonly in UK practice two embryos are transferred (double embryo transfer, DET). IVF techniques have led to an increase in the number of multiple births, carrying an increased risk of maternal and infant morbidity. The UK Human Fertilisation and Embryology Authority (HFEA) has adopted a multiple birth minimisation strategy. One way of achieving this would be by increased use of single embryo transfer (SET). To collate cohort data from treatment centres and the HFEA; to develop predictive models for live birth and twinning probabilities from fresh and frozen embryo transfers and predict outcomes from treatment scenarios; to understand patients' perspectives and use the modelling results to investigate the acceptability of twin reduction policies. A multidisciplinary approach was adopted, combining statistical modelling with qualitative exploration of patients' perspectives: interviews were conducted with 27 couples at various stages of IVF treatment at both UK NHS and private clinics; datasets were collated of over 90,000 patients from the HFEA registry and nearly 9000 patients from five clinics, both over the period 2000-5; models were developed to determine live birth and twin outcomes and predict the outcomes of policies for selecting patients for SET or DET in the fresh cycle following egg retrieval and fertilisation, and the predictions were used in simulations of treatments; two focus groups were convened, one NHS and one web based on a patient organisation's website, to present the results of the statistical analyses and explore potential treatment policies. The statistical analysis revealed no characteristics that

  10. Adoptive cell transfer after chemotherapy enhances survival in patients with resectable HNSCC.

    Science.gov (United States)

    Jiang, Pan; Zhang, Yan; J Archibald, Steve; Wang, Hua

    2015-09-01

    The aims of this study were to evaluate the therapeutic efficacy and to determine the immune factors for treatment success in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemotherapy followed by adoptive cell transfer (ACT). A total of 43 HNSCC patients who received radical resection and chemotherapy were analysed in this study. Twenty-one of the patients were repeatedly treated with ACT after chemotherapy (ACT group), and the other twenty-two patients without ACT treatment were included as part of the control group. To investigate the immunological differences underlying these observations, we expanded and profiled improving cytokine-induced killer cells (iCIK) from peripheral blood mononuclear cells (PBMCs) with the timed addition of RetroNectin, OKT3 mAb, IFN γ and IL-2. The median of progression-free survival (PFS) and overall survival (OS) in the ACT group were significantly higher as compared to the control group (56 vs. 40; 58 vs. 45 months). In iCIK culture, there was a significant reduction in CD3+CD4+ T-cell proliferation and cytokines (IL-2, TNF) production from patients who received chemotherapy compared to patients without chemotherapy. Intra-arterial infusion of iCIK, in coordination with chemotherapy, considerably rescued iCIK culture from the suppression of systemic immunity induced by chemotherapy and induced tumour regression. Altogether, these findings suggest that ACT is an effective neo-adjuvant therapy for rescuing systemic immune suppression and improving survival time in patients with HNSCC. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Rehabilitation of the elbow extension with motor imagery in a patient with quadriplegia after tendon transfer.

    Science.gov (United States)

    Grangeon, Murielle; Guillot, Aymeric; Sancho, Pierre-Olivier; Picot, Marion; Revol, Patrice; Rode, Gilles; Collet, Christian

    2010-07-01

    To test the effect of a postsurgical motor imagery program in the rehabilitation of a patient with quadriplegia. Crossover design with kinematic analysis. Rehabilitation Hospital of Lyon. Study approved by the local Human Research Ethics Committee. C6-level injured patient (American Spinal Injury Association Impairment Scale grade A) with no voluntary elbow extension (triceps brachialis score 1). The surgical procedure was to transfer the distal insertion of the biceps brachii onto the triceps tendon of both arms. The postsurgical intervention on the left arm included 10 sessions of physical rehabilitation followed by 10 motor imagery sessions of 30 minutes each. The patient underwent 5 sessions a week during 2 consecutive weeks. The motor imagery content included mental representations based on elbow extension involved in goal-directed movements. The rehabilitation period of the right arm was reversed, with motor imagery performed first, followed by physical therapy. The kinematics of upper-limb movements was recorded (movement time and variability) before and after each type of rehabilitation period. A long-term retention test was performed 1 month later. Motor imagery training enhanced motor recovery by reducing hand trajectory variability-that is, improving smoothness. Motor performance then remained stable over 1 month. Motor imagery improved motor recovery when associated with physical therapy, with motor performance remaining stable over the 1-month period. We concluded that motor imagery should be successfully associated with classic rehabilitation procedure after tendon transfer. Physical sessions may thus be shortened if too stressful or painful. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Defining the eHealth Information Niche in the Family Physician/Patient Examination and Knowledge Transfer Process

    Science.gov (United States)

    Ellington, Virginia Beth Elder

    2012-01-01

    This research study was undertaken to gain a richer understanding of the use of patient-introduced online health information during the physician/patient examination and knowledge transfer process. Utilizing qualitative data obtained from ten family physician interviews and workflow modeling using activity diagrams and task structure charts, this…

  13. Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU

    NARCIS (Netherlands)

    Droogh, Joep M; Kruger, H. L.; Ligtenberg, Jack J M; Zijlstra, Jan G

    2012-01-01

    BACKGROUND: Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a

  14. Whole brain magnetization transfer histogram analysis of pediatric acute lymphoblastic leukemia patients receiving intrathecal methotrexate therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Akira [Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: yakira@kuhp.kyoto-u.ac.jp; Miki, Yukio [Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: mikiy@kuhp.kyoto-u.ac.jp; Adachi, Souichi [Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: sadachi@kuhp.kyoto-u.ac.jp (and others)

    2006-03-15

    Background and purpose: The purpose of this prospective study was to evaluate the hypothesis that magnetization transfer ratio (MTR) histogram analysis of the whole brain could detect early and subtle brain changes nonapparent on conventional magnetic resonance imaging (MRI) in children with acute lymphoblastic leukemia (ALL) receiving methotrexate (MTX) therapy. Materials and methods: Subjects in this prospective study comprised 10 children with ALL (mean age, 6 years; range, 0-16 years). In addition to conventional MRI, magnetization transfer images were obtained before and after intrathecal and intravenous MTX therapy. MTR values were calculated and plotted as a histogram, and peak height and location were calculated. Differences in peak height and location between pre- and post-MTX therapy scans were statistically analyzed. Conventional MRI was evaluated for abnormal signal area in white matter. Results: MTR peak height was significantly lower on post-MTX therapy scans than on pre-MTX therapy scans (p = 0.002). No significant differences in peak location were identified between pre- and post-chemotherapy imaging. No abnormal signals were noted in white matter on either pre- or post-MTX therapy conventional MRI. Conclusions: This study demonstrates that MTR histogram analysis allows better detection of early and subtle brain changes in ALL patients who receive MTX therapy than conventional MRI.

  15. Using a simulated patient to transfer patient-centred skills from simulated practice to real patients in practice

    Directory of Open Access Journals (Sweden)

    Yolinda Uys

    2014-11-01

    Conclusion: Using a simulated patient to teach administration of an intramuscular injection enhanced students’ patient-centredness when performing the procedure in practice. Recommendations include making use of a bigger sample and including a pre-test the next time research of this nature is carried out.

  16. Free tissue transfer in patients with sickle cell disease: Considerations for multi-disciplinary peri-operative management.

    Science.gov (United States)

    Cooper, Lilli; Seth, Rohit; Rhodes, Elizabeth; Alousi, Mohammed; Sivakumar, Bran

    2017-01-01

    Sickle cell disease (SCD) is an increasingly common condition in the UK. The safety of free tissue transfer in these patients is controversial, and no specific guidelines exist. The aim of this paper is to create recommendations for the plastic surgical multidisciplinary team for use in the assessment and management of SCD patients undergoing free tissue transfer and reconstruction. A literature review was performed in PubMed of 'sickle [TiAb] AND plast* adj3 surg*. Sickle cell disease is explained, as is the relative peri-operative risk in different genotypes of SCD. Acute and chronic manifestations of SCD are described by system, for consideration at pre-operative assessment and post-operative review. The evidence surrounding free tissue transfer and SCD is discussed and the outcomes in published cases summarised. An algorithm for peri-operative multi-disciplinary management is outlined and justified. Free tissue transfer theoretically carries a high risk of a crisis, due not only to long anaesthetic times, but the potential requirement for tourniquet use, and the relatively hypoxic state of the transferred tissue. This paper outlines a useful, practical algorithm to optimise the safety of free tissue transfer in patients with SCD. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

    Science.gov (United States)

    Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

    2011-08-01

    Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

  18. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection.

    Science.gov (United States)

    Rogers, Benjamin A; Aminzadeh, Zohreh; Hayashi, Yoshiro; Paterson, David L

    2011-07-01

    Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-β-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

  19. Transfer of patients from health care centres to special care services: analysis of travel distances in Nordic countries.

    Science.gov (United States)

    Vuori, Jari; Kylänen, Marika; Tritter, Jonathan

    2010-12-01

    This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implications. An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Finnish patients have limited access to health care services in circumpolar areas across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, the Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

  20. T2 relaxation time analysis in patients with multiple sclerosis: correlation with magnetization transfer ratio

    International Nuclear Information System (INIS)

    Papanikolaou, Nickolas; Papadaki, Eufrosini; Karampekios, Spyros; Maris, Thomas; Prassopoulos, Panos; Gourtsoyiannis, Nicholas; Spilioti, Martha

    2004-01-01

    The aim of the current study was to perform T2 relaxation time measurements in multiple sclerosis (MS) patients and correlate them with magnetization transfer ratio (MTR) measurements, in order to investigate in more detail the various histopathological changes that occur in lesions and normal-appearing white matter (NAWM). A total number of 291 measurements of MTR and T2 relaxation times were performed in 13 MS patients and 10 age-matched healthy volunteers. Measurements concerned MS plaques (105), NAWM (80), and ''dirty'' white matter (DWM; 30), evenly divided between the MS patients, and normal white matter (NWM; 76) in the healthy volunteers. Biexponential T2 relaxation-time analysis was performed, and also possible linearity between MTR and mean T2 relaxation times was evaluated using linear regression analysis in all subgroups. Biexponential relaxation was more pronounced in ''black-hole'' lesions (16.6%) and homogeneous enhancing plaques (10%), whereas DWM, NAWM, and mildly hypointense lesions presented biexponential behavior with a lower frequency(6.6, 5, and 3.1%, respectively). Non-enhancing isointense lesions and normal white matter did not reveal any biexponentional behavior. Linear regression analysis between monoexponential T2 relaxation time and MTR measurements demonstrated excellent correlation for DWM(r=-0.78, p<0.0001), very good correlation for black-hole lesions(r=-0.71, p=0.002), good correlation for isointense lesions(r=-0.60, p=0.005), moderate correlation for mildly hypointense lesions(r=-0.34, p=0.007), and non-significant correlation for homogeneous enhancing plaques, NAWM, and NWM. Biexponential T2 relaxation-time behavior is seen in only very few lesions (mainly on plaques with high degree of demyelination and axonal loss). A strong correlation between MTR and monoexponential T2 values was found in regions where either inflammation or demyelination predominates; however, when both pathological conditions coexist, this linear

  1. Increasing The Number of Embryos Transferred from Two to Three, Does not Increase Pregnancy Rates in Good Prognosis Patients

    Directory of Open Access Journals (Sweden)

    Mahnaz Ashrafi

    2015-10-01

    Full Text Available Background: To compare the pregnancy outcomes after two embryos versus three embryos transfers (ETs in women undergoing in vitro fertilization (IVF/intracytoplasmic sperm injection (ICSI cycles. Materials and Methods: This retrospective study was performed on three hundred eighty seven women with primary infertility and with at least one fresh embryo in good quality in order to transfer at each IVF/ICSI cycle, from September 2006 to June 2010. Patients were categorized into two groups according to the number of ET as follows: ET2 and ET3 groups, indicating two and three embryos were respectively transferred. Pregnancy outcomes were compared between ET2 and ET3 groups. Chi square and student t tests were used for data analysis. Results: Clinical pregnancy and live birth rates were similar between two groups. The rates of multiple pregnancies were 27 and 45.2% in ET2 and ET3 groups, respectively. The rate of multiple pregnancies in young women was significantly increased when triple instead of double embryos were transferred. Logistic regression analysis indicated two significant prognostic variables for live birth that included number and quality of transferred embryos; it means that the chance of live birth following ICSI treatment increased 3.2-fold when the embryo with top quality (grade A was transferred, but the number of ET had an inverse relationship with live birth rate; it means that probability of live birth in women with transfer of two embryos was three times greater than those who had three ET. Conclusion: Due to the difficulty of implementation of the elective single-ET technique in some infertility centers in the world, we suggest transfer of double instead of triple embryos when at least one good quality embryo is available for transfer in women aged 39 years or younger. However, to reduce the rate of multiple pregnancies, it is recommended to consider the elective single ET strategy.

  2. Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors.

    Science.gov (United States)

    Choi, Iee; Kim, Jin Kyu; Kim, Sun Jun; Cho, Soo Chul; Kim, Il Nyeo

    2016-08-04

    The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users' requirements should be

  3. Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors

    Science.gov (United States)

    Choi, Iee; Kim, Sun Jun; Cho, Soo Chul; Kim, Il Nyeo

    2016-01-01

    Background The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. Objective In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Methods Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. Results The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). Conclusions The users were highly satisfied and different users indicated different factors of satisfaction. This finding

  4. Measurement of action forces and posture to determine the lumbar load of healthcare workers during care activities with patient transfers.

    Science.gov (United States)

    Theilmeier, Andreas; Jordan, Claus; Luttmann, Alwin; Jäger, Matthias

    2010-11-01

    Moving patients or other care activities with manual patient handling is characterized by high mechanical load on the lumbar spine of healthcare workers (HCWs). During the patient transfer activity, the caregivers exert lifting, pulling, and pushing forces varying over time with respect to amplitude and direction. Furthermore, the caregivers distinctly change their posture and frequently obtain postures asymmetrical to the median sagittal plane, including lateral bending and turning the trunk. This paper describes a procedure to determine lumbar load during patient transfer supported by measurement techniques and an exemplary application; this methodology represents the basis of a complex research project, the third 'Dortmund Lumbar Load Study (DOLLY 3)'. Lumbar load was determined by simulation calculations using a comprehensive biomechanical model ('The Dortmunder'). As the main influencing factors, the hand forces of the caregiver exerted during typical patient transfers and the posture and movements of the HCW were recorded in laboratory studies. The action forces were determined three-dimensionally with the help of a newly developed 'measuring bed', two different 'measuring chairs', a 'measuring bathtub', and a 'measuring floor'. To capture the forces during transfers in or at the bed, a common hospital bed was equipped with an additional framework, which is attached to the bedstead and connected to the bedspring frame via three-axial force sensors at the four corners. The other measuring systems were constructed similarly. Body movements were recorded using three-dimensional optoelectronic recording tools and video recordings. The posture and force data served as input data for the quantification of various lumbar-load indicators.

  5. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients--a randomized controlled trial

    DEFF Research Database (Denmark)

    Todsen, Tobias; Jensen, Morten Lind; Tolsgaard, Martin Grønnebæk

    2016-01-01

    BACKGROUND: Clinicians are increasingly using point-of-care ultrasonography for bedside examinations of patients. However, proper training is needed in this technique, and it is unknown whether the skills learned from focused Ultrasonography courses are being transferred to diagnostic performance...... test and binary logistic regression, respectively. RESULTS: There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014......). CONCLUSIONS: Clinicians could successfully transfer learning from an Ultrasonography course to improve diagnostic performance on patients. However, our results also indicate a need for more training when new technologies such as point-of-care ultrasonography are introduced....

  6. Hurdles overcome in technology transfer for AIET and Positive outcome in Indian patients

    Directory of Open Access Journals (Sweden)

    Dedeepiya V

    2012-01-01

    experienced. An increase in awareness about this least toxic method of Cancer treatment among physicians and the public for an early referral is necessary. Further studies on prevention of cancer using in vitro expanded autologous immune cells are underway. References: 1.Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000 ;356(9232:802-7. 2.Kimura H, Yamaguchi Y. A phase III randomized study of interleukin-2 lymphokine-activated killer cell immunotherapy combined with chemotherapy or radiotherapy after curative or noncurative resection of primary lung carcinoma. Cancer. 1997;80(1:42-9. 3.Kono K, Takahashi A, Ichihara F, Amemiya H, Iizuka H, Fujii H, Sekikawa T, Matsumoto Y: Prognostic significance of adoptive immunotherapy with tumor-associated lymphocytes in patients with advanced gastric cancer: a randomized trial. Clin Cancer Res. 2002; 8 : 1767-71. 4.Fujita K, Ikarashi H, Takakuwa K, Kodama S, Tokunaga A, Takahashi T, Tanaka K. Prolonged disease-free period in patients with advanced epithelial ovarian cancer after adoptive transfer of tumor-infiltrating lymphocytes. Clin Cancer Res. 1995;1(5:501-7.5.Sivaraman G, Pandian A, Baskar S, Senthil KR, Senthilnagarajan R, Dedeepiya V, Abraham S. Autologous Immune Enhancement therapy for advanced carcinoma of pancreas a case report. PASRM 2008-004. J Stem Cells Regen Med. 2008; 4(1:136.Damodar S, Terunuma H , Sheriff AK , Farzana L , Manjunath S , Senthilkumar R , Shastikumar G , Abraham S , Wang FS. Autologous Immune Enhancement Therapy (AIET for a Case of Acute Myeloid Leukemia (AML - Our Experience. PASRM 2006-001. J Stem Cells Regen Med. 2006, 1(1: 40-417.Takada M, Terunuma H, Deng X, Dewan MZ, Saji S, Kuroi K, Yamamoto N, Toi M. Refractory lung metastasis from breast cancer treated with multidisciplinary therapy including an

  7. Effects of Transfer Training on Musculoskeletal pain in the Caregiver of a Stroke Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    Atefeh Taghizadeh

    2015-06-01

    Full Text Available The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week, training (3rd, 5th and 7th week, post-training (9th week, and follow-up evaluation (11th week. During the 1st week, demographic and descriptive information  (such as age, time since diagnosis, cognition and independence of daily living were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors.

  8. Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression.

    Directory of Open Access Journals (Sweden)

    Mweete D Nglazi

    Full Text Available To determine the proportion, characteristics and outcomes of patients who transfer-out from an antiretroviral therapy (ART service in a South African township.This retrospective cohort study included all patients aged ≥15 years who enrolled between September 2002 and December 2009. Follow-up data were censored in December 2010. Kaplan-Meier survival analysis was used to describe time to transfer-out and cox proportional hazard analysis was used to determine associated risk factors.4511 patients (4003 ART-naïve and 508 non-naïve at baseline received ART during the study period. Overall, 597 (13.2% transferred out. The probability of transferring out by one year of ART steadily increased from 1.4% in 2002/2004 cohort to 8.9% for the 2009 cohort. Independent risk factors for transfer-out were more recent calendar year of enrolment, younger age (≤25 years and being ART non-naïve at baseline (i.e., having previously transferred into this clinic from another facility. The proportions of patients transferred out who had a CD4 cell count 1000 copies/mL around the time of transfer, suggesting the need for careful adherence counseling and assessment of medication supplies among those planning transfer.

  9. The Use of the Self-Standing Turning Transfer Device to Perform Bed-To-Chair Transfers Reduces Physical Stress among Caregivers of Older Patients in a Middle-Income Developing Country.

    Science.gov (United States)

    Goh, Choon Hian; Muslimah Y; Ng, Siew-Cheok; Subramanian, Pathmawathi; Tan, Maw Pin

    2014-01-01

    Manual transfer of elderly patients remains commonplace in many developing countries because the use of lifting equipment, such as hoists, is often considered unaffordable luxuries. The aim of this study was, therefore, to evaluate the usage and potential benefits of a low-cost, mechanical turning transfer device among elderly patients and their caregivers on a geriatric ward in a developing country in South East Asia. Fifty-six inpatients, aged 66-92 years, on a geriatric ward, and their caregivers were recruited. Participants were asked to transfer from bed-to-chair transfer with manual assistance, and the task was repeated using the Self-standing Turning Transfer Device (STurDi). The time taken to perform manual transfers and STurDi-assisted transfers was recorded. Physical strain was assessed using the perceived physical stress-rating tool for caregivers with and without the use of the device. User satisfaction was evaluated using the usefulness, satisfaction, and ease of use questionnaire. There was a significant reduction in transfer-time with manual transfers compared to STurDi-assisted transfers [mean (SD) = 48.39 (13.98) vs. 36.23 (10.96); p ≤ 0.001]. The physical stress rating was significantly lower in STurDi-aided transfers compared to manual transfers, shoulder [median (interquartile range) = 0 (1) vs. 4 (3); p = 0.001], upper back [0 (0) vs. 5 (4); p = 0.001], lower back [0 (1) vs. 5 (3), p = 0.001], whole body [1 (2) vs. 4 (3), p = 0.001], and knee [0 (1) vs. 1 (4), p = 0.001]. In addition, majority of patients and caregivers definitely or strongly agreed that the device was useful, saved time, and was easy to use. We have therefore demonstrated in a setting where manual handling was commonly performed that a low-cost mechanical transfer device reduced caregiver strain and was well received by older patients and caregivers.

  10. Clinical Improvement by Switching to an Integrase Strand Transfer Inhibitor in Hemophiliac Patients with HIV: The Japan Cohort Study of HIV Patients Infected through Blood Products.

    Science.gov (United States)

    Kawado, Miyuki; Hashimoto, Shuji; Oka, Shin-Ichi; Fukutake, Katsuyuki; Higasa, Satoshi; Yatsuhashi, Hiroshi; Ogane, Miwa; Okamoto, Manabu; Shirasaka, Takuma

    2017-01-01

    This study aimed to determine improvement in HIV RNA levels and the CD4 cell count by switching to an antiretroviral regimen with an integrase strand transfer inhibitor (INSTI) in patients with HIV. This study was conducted on Japanese patients with HIV who were infected by blood products in the 1980s. Data were collected between 2007 and 2014. Data of 564 male hemophiliac patients with HIV from the Japan Cohort Study of HIV Patients Infected through Blood Products were available. Changes in antiretroviral regimen use, HIV RNA levels, and the CD4 cell count between 2007 and 2014 were examined. From 2007 to 2014, the proportion of use of a regimen with an INSTI increased from 0.0% to 41.0%. For patients with HIV who used a regimen, including an INSTI, the proportion of HIV RNA levels products. This suggests that performing this switch in clinical practice will lead to favorable effects.

  11. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ho, Chi-Kung; Chen, Fu-Cheng; Chen, Yung-Lung; Wang, Hui-Ting; Lee, Chien-Ho; Chung, Wen-Jung; Lin, Cheng-Jui; Hsueh, Shu-Kai; Hung, Shin-Chiang; Wu, Kuan-Han; Liu, Chu-Feng; Kung, Chia-Te; Cheng, Cheng-I

    2017-01-01

    This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p cloud computing system in our present protocol did not reduce DTB time.

  12. Transfer of liraglutide from blood to cerebrospinal fluid is minimal in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Christensen, M; Sparre-Ulrich, A H; Hartmann, B

    2015-01-01

    Treatment with liraglutide leads to weight loss. We investigated whether blood-to-cerebrospinal fluid (CSF) transfer of liraglutide occurs, and if so, whether it associates with clinical weight loss following liraglutide treatment in humans. We performed lumbar puncture and blood sampling in eight...

  13. Quality-of-life improvement after free gracilis muscle transfer for smile restoration in patients with facial paralysis.

    Science.gov (United States)

    Lindsay, Robin W; Bhama, Prabhat; Hadlock, Tessa A

    2014-01-01

    Facial paralysis can contribute to disfigurement, psychological difficulties, and an inability to convey emotion via facial expression. In patients unable to perform a meaningful smile, free gracilis muscle transfer (FGMT) can often restore smile function. However, little is known about the impact on disease-specific quality of life. To determine quantitatively whether FGMT improves quality of life in patients with facial paralysis. Prospective evaluation of 154 FGMTs performed at a facial nerve center on 148 patients with facial paralysis. The Facial Clinimetric Evaluation (FaCE) survey and Facial Assessment by Computer Evaluation software (FACE-gram) were used to quantify quality-of-life improvement, oral commissure excursion, and symmetry with smile. Free gracilis muscle transfer. Change in FaCE score, oral commissure excursion, and symmetry with smile. There were 127 successful FGMTs on 124 patients and 14 failed procedures on 13 patients. Mean (SD) FaCE score increased significantly after successful FGMT (42.30 [15.9] vs 58.5 [17.60]; paired 2-tailed t test, P improved significantly in all subgroups (nonflaccid cohort, 37.8 [19.9] vs 52.9 [19.3]; P = .02; flaccid cohort, 43.1 [15.1] vs 59.6 [17.2]; P improved from a mean (SD) of 13.8 (7.46) to 4.88 (3.47) (P improvement in quality of life after FGMT in patients who could not recover a meaningful smile after facial nerve insult. Quality-of-life improvement was not statistically different between donor nerve groups or facial paralysis types.

  14. Serial contrast-enhanced magnetic resonance and magnetization transfer in the study of patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Rovira, A.; Alonso, J.; Cucurella, G.; Nos, C.; Tintore, M.; Pedraza, S.; Rio, J.; Montalban, X.

    1997-01-01

    To demonstrate the changes in the magnetization transfer ratio (MTR) of different demyelinating plaques, correlating them with the baseline values in T1-weighted contrast-enhanced magnetic resonance (MR) sequences in order to relate them more closely to the underlying disease. The study was based on 33 demyelinating plaques obtained from six patients clinically diagnosed as having remitting-recurring multiple sclerosis (MS). All the patients underwent two MR studies at a 3 to 5-month interval, including contrast-enhanced T1 and T2- weighted sequences and magnetization transfer images. The latter were used to calculate the MTR for each of the demyelinating plaques included in the study. The statistical analysis of the results obtained revealed statistically significant between initial MTR values and those of subsequent T1-weighted sequences. The MTR demonstrate significant differences between plaques according to contrast-enhanced T1-weigh tes sequences, probably indicating variable degrees of edema, demyelination and tissue destruction. These differences should be taken into account to enable the use of T1-weighted sequences to quantify the lesion load in MS patients. (Author) 35 refs

  15. Pathological Assessment of Brain White Matter in Relapsing-Remitting MS Patients using Quantitative Magnetization Transfer Imaging

    Directory of Open Access Journals (Sweden)

    Khodarahm Pahlevan

    2011-09-01

    Full Text Available Introduction: Multiple sclerosis (MS is characterized by lesions in the white matter (WM of the central nervous system. Magnetic resonance imaging is the most specific and sensitive method for diagnosis of multiple sclerosis. However, the ability of conventional MRI to show histopathologic heterogeneity of MS lesions is insufficient. Quantitative magnetization transfer imaging (qMTI is a relatively new method to investigate pathologic processes of the brain tissue occurring in MS patients. Material and Methods: Voxel-based analyses allow regional comparisons between groups to be made for the whole brain in a single analysis. This is done by coregistering data from all individual subjects to a reference brain, generally referred to as the "standard space", and then comparing them on a voxel-by-voxel basis. This study aimed to analyze whole-brain quantitative T1 maps, not to find global changes or changes in selected regions, but specifically to investigate the spatial distribution throughout the brain of T1 increases in MS WM with respect to control WM. In this study, 11 healthy controls, 10 relapsing-remitting (RR MS patients and 13 CIS patients were studied using MT-MRI imaging. MT parameters, including magnetization transfer ratio (MTR, magnetization transfer rate between free protons and restricted macromolecular protons, Ksat and longitudinal relaxation times (with and without MT saturation pulse, T1sat and T1free values were evaluated. Results: The results showed that, at a group level, there is widespread involvement of WM throughout the brain in CIS MS and especially in RRMS, where a significant T1 increase was found in 15.58% of WM voxels (normals < RR. Discussion and Conclusion: This study demonstrates that WM in large parts of the brain is susceptible to disease processes in RR and CIS MS

  16. Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

    Science.gov (United States)

    Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

    2016-08-01

    Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

  17. "One for Sorrow, Two for Joy?": American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients.

    Science.gov (United States)

    White, Pamela M

    2017-04-01

    In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple-birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father, went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multiple-embryo transfers in the context of US surrogacy arrangements. Offering an original analysis of data obtained from the US national-assisted reproduction registry, it examines single- and multiple-embryo transfer trends over a 12-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in fewer than 42% of the cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemented.

  18. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Chi-Kung Ho

    2017-01-01

    Full Text Available Background. This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB time for ST segment elevation myocardial infarction (STEMI. Methods. A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. Results. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p<0.05. There were also no remarkable differences in the complication rate and 30-day mortality between two groups. The multivariate analysis revealed that the independent predictors of 30-day mortality were elderly patients, advanced Killip score, and higher level of troponin-I. Conclusions. This study showed that patients transferred through our present protocol could reduce pain to electrocardiography and catheterization laboratory to balloon time in Killip I/II and III/IV patients separately. However, this study showed that using a cloud computing system in our present protocol did not reduce DTB time.

  19. Heat-transfer-based detection of SNPs in the PAH gene of PKU patients

    Directory of Open Access Journals (Sweden)

    Vanden Bon N

    2014-03-01

    Full Text Available Natalie Vanden Bon,1 Bart van Grinsven,2 Mohammed Sharif Murib,2 Weng Siang Yeap,2 Ken Haenen,2,3 Ward De Ceuninck,2,3 Patrick Wagner,2,3 Marcel Ameloot,1 Veronique Vermeeren,1 Luc Michiels11Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium; 2Institute for Materials Research, Hasselt University, Diepenbeek, Belgium; 3IMOMEC, Diepenbeek, BelgiumAbstract: Conventional neonatal diagnosis of phenylketonuria is based on the presence of abnormal levels of phenylalanine in the blood. However, for carrier detection and prenatal diagnosis, direct detection of disease-correlated mutations is needed. To speed up and simplify mutation screening in genes, new technologies are developed. In this study, a heat-transfer method is evaluated as a mutation-detection technology in entire exons of the phenylalanine hydroxylase (PAH gene. This method is based on the change in heat-transfer resistance (Rth upon thermal denaturation of dsDNA (double-stranded DNA on nanocrystalline diamond. First, ssDNA (single-stranded DNA fragments that span the size range of the PAH exons were successfully immobilized on nanocrystalline diamond. Next, it was studied whether an Rth change could be observed during the thermal denaturation of these DNA fragments after hybridization to their complementary counterpart. A clear Rth shift during the denaturation of exon 5, exon 9, and exon 12 dsDNA was observed, corresponding to lengths of up to 123 bp. Finally, Rth was shown to detect prevalent single-nucleotide polymorphisms, c.473G>A (R158Q, c.932T>C (p.L311P, and c.1222C>T (R408W, correlated with phenylketonuria, displaying an effect related to the different melting temperatures of homoduplexes and heteroduplexes.Keywords: mutation detection, heat-transfer resistance, melting temperature, nanocrystalline diamond, persistence length

  20. HIV-particles in spermatozoa of patients with AIDS and their transfer into the oocyte

    Science.gov (United States)

    Baccetti, B; Benedetto, A; Burrini, AG; Collodel, G; Ceccarini, EC; Crisa, N; Di Caro, A; Estenoz, M; Garbuglia, AR; Massacesi, A; Piomboni, P; Renieri, T; Solazzo, D

    1994-01-01

    By immunocytochemistry and in situ hybridization at the electron microscopy level, and by the PCR technique, we have shown that HIV-1 binds and enters normal sperm; that viral particles, their antigens, and nucleic acid are present in sperm from HIV-1 infected men; and that such sperm can transfer HIV-1 like particles to normal human oocytes. We also present evidence that a galactosylceramide-like compound is present on the sperm membrane and could function as an alternative receptor for HIV. PMID:7962075

  1. [Development of Patient Transfer Techniques based on Postural-stability Principles for the Care Helpers in Nursing Homes and Evaluation of Effectiveness].

    Science.gov (United States)

    Ma, Ryewon; Jung, Dukyoo

    2016-02-01

    This study was done to develop a postural-stability patient transfer technique for care helpers in nursing homes and to evaluate its effectiveness. Four types of patient transfer techniques (Lifting towards the head board of the bed, turning to the lateral position, sitting upright on the bed, transferring from wheel chair to bed) were practiced in accordance with the following three methods; Care helpers habitually used transfer methods (Method 1), patient transfer methods according to care helper standard textbooks (Method 2), and a method developed by the author ensuring postural-stability (Method 3). The care helpers' muscle activity and four joint angles were measured. The collected data were analyzed using the program SPSS Statistic 21.0. To differentiate the muscle activity and joint angle, the Friedman test was executed and the post-hoc analysis was conducted using the Wilcoxon Signed Rank test. Muscle activity was significantly lower during Method 3 compared to Methods 1 and 2. In addition, the joint angle was significantly lower for the knee and shoulder joint angle while performing Method 3 compared to Methods 1 and 2. Findings indicate that using postural-stability patient transfer techniques can contribute to the prevention of musculoskeletal disease which care helpers suffer from due to physically demanding patient care in nursing homes.

  2. Correction of glucocerebrosidase deficiency after retroviral-mediated gene transfer into hematopoietic progenitor cells from patients with Gaucher disease

    International Nuclear Information System (INIS)

    Fink, J.K.; Correll, P.H.; Perry, L.K.; Brady, R.O.; Karlsson, S.

    1990-01-01

    Retroviral gene transfer has been used successfully to correct the glucocerebrosidase (GCase) deficiency in primary hematopoietic cells from patients with Gaucher disease. For this model of somatic gene therapy, the authors developed a high-titer, amphotropic retroviral vector designated NTG in which the human GCase gene was driven by the mutant polyoma virus enhancer/herpesvirus thymidine kinase gene (tk) promoter (Py + /Htk). NTG normalized GCase activity in transduced Gaucher fibroblasts and efficiently infected human monocytic and erythroleukemic cell lines. RNA blot-hybridization (Northern blot) analysis of these hemaptopoietic cell lines showed unexpectedly high-level expression from the Moloney murine leukemia virus long terminal repeat (Mo-MLV LTR) and levels of Py + /Htk enhancer/promoter-initiated human GCase RNA that approximated endogenous GCase RNA levels. Furthermore, NTG efficiently infected human hematopoietic progenitor cells. Detection of the provirus in approximately one-third of NTG-infected progenitor colonies that had not been selected in G418-containing medium indicates that relative resistance to G418 underestimated the actual gene transfer efficiency. Northern blot analysis of NTG-infected, progenitor-derived cells showed expression from both the Mo-MLV LTR and the Py + /Htk enhancer/promoter. NTG-transduced hematopoietic progenitor cells from patients with Gaucher disease generated progeny in which GCase activity has been normalized

  3. Correction of glucocerebrosidase deficiency after retroviral-mediated gene transfer into hematopoietic progenitor cells from patients with Gaucher disease

    Energy Technology Data Exchange (ETDEWEB)

    Fink, J.K.; Correll, P.H.; Perry, L.K.; Brady, R.O.; Karlsson, S. (National Institutes of Health, Bethesda, MD (USA))

    1990-03-01

    Retroviral gene transfer has been used successfully to correct the glucocerebrosidase (GCase) deficiency in primary hematopoietic cells from patients with Gaucher disease. For this model of somatic gene therapy, the authors developed a high-titer, amphotropic retroviral vector designated NTG in which the human GCase gene was driven by the mutant polyoma virus enhancer/herpesvirus thymidine kinase gene (tk) promoter (Py{sup +}/Htk). NTG normalized GCase activity in transduced Gaucher fibroblasts and efficiently infected human monocytic and erythroleukemic cell lines. RNA blot-hybridization (Northern blot) analysis of these hemaptopoietic cell lines showed unexpectedly high-level expression from the Moloney murine leukemia virus long terminal repeat (Mo-MLV LTR) and levels of Py{sup +}/Htk enhancer/promoter-initiated human GCase RNA that approximated endogenous GCase RNA levels. Furthermore, NTG efficiently infected human hematopoietic progenitor cells. Detection of the provirus in approximately one-third of NTG-infected progenitor colonies that had not been selected in G418-containing medium indicates that relative resistance to G418 underestimated the actual gene transfer efficiency. Northern blot analysis of NTG-infected, progenitor-derived cells showed expression from both the Mo-MLV LTR and the Py{sup +}/Htk enhancer/promoter. NTG-transduced hematopoietic progenitor cells from patients with Gaucher disease generated progeny in which GCase activity has been normalized.

  4. Clinical validity of a relocation stress scale for the families of patients transferred from intensive care units.

    Science.gov (United States)

    Oh, HyunSoo; Lee, Seul; Kim, JiSun; Lee, EunJu; Min, HyoNam; Cho, OkJa; Seo, WhaSook

    2015-07-01

    This study was conducted to develop a family relocation stress scale by modifying the Son's Relocation Stress Syndrome Scale, to examine its clinical validity and reliability and to confirm its suitability for measuring family relocation stress. The transfer of ICU patients to general wards is a significant anxiety-producing event for family members. However, no relocation stress scale has been developed specifically for families. A nonexperimental, correlation design was adopted. The study subjects were 95 family members of 95 ICU patients at a university hospital located in Incheon, South Korea. Face and construct validities of the devised family relocation stress scale were examined. Construct validity was examined using factor analysis and by using a nomological validity test. Reliability was also examined. Face and content validity of the scale were verified by confirming that its items adequately measured family relocation stress. Factor analysis yielded four components, and the total variance explained by these four components was 63·0%, which is acceptable. Nomological validity was well supported by significant relationships between relocation stress and degree of preparation for relocation, patient self-care ability, family burden and satisfaction with the relocation process. The devised scale was also found to have good reliability. The family relocation stress scale devised in this study was found to have good validity and reliability, and thus, is believed to offer a means of assessing family relocation stress. The findings of this study provide a reliable and valid assessment tool when nurses prepare families for patient transfer from an ICU to a ward setting, and may also provide useful information to those developing an intervention programme for family relocation stress management. © 2015 John Wiley & Sons Ltd.

  5. Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review.

    Science.gov (United States)

    de Mendonça Cardoso, Marcio; Gepp, Ricardo; Correa, José Fernando Guedes

    2016-09-01

    The phrenic nerve can be transferred to the musculocutaneous nerve in patients with traumatic brachial plexus palsy in order to recover biceps strength, but the results are controversial. There is also a concern about pulmonary function after phrenic nerve transection. In this paper, we performed a qualitative systematic review, evaluating outcomes after this procedure. A systematic review of published studies was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Data were extracted from the selected papers and related to: publication, study design, outcome (biceps strength in accordance with BMRC and pulmonary function) and population. Study quality was assessed using the "strengthening the reporting of observational studies in epidemiology" (STROBE) standard or the CONSORT checklist, depending on the study design. Seven studies were selected for this systematic review after applying inclusion and exclusion criteria. One hundred twenty-four patients completed follow-up, and most of them were graded M3 or M4 (70.1 %) for biceps strength at the final evaluation. Pulmonary function was analyzed in five studies. It was not possible to perform a statistical comparison between studies because the authors used different parameters for evaluation. Most of the patients exhibited a decrease in pulmonary function tests immediately after surgery, with recovery in the following months. Study quality was determined using STROBE in six articles, and the global score varied from 8 to 21. Phrenic nerve transfer to the musculocutaneous nerve can recover biceps strength ≥M3 (BMRC) in most patients with traumatic brachial plexus injury. Early postoperative findings revealed that the development of pulmonary symptoms is rare, but it cannot be concluded that the procedure is safe because there is no study evaluating pulmonary function in old age.

  6. Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition.

    Science.gov (United States)

    Cole, Rebecca; Ashok, Dhandapani; Razack, Abdul; Azaz, Amer; Sebastian, Shaji

    2015-08-01

    We aimed to evaluate the impact of a transition service on clinical and developmental outcomes in adolescent Inflammatory Bowel Disease (IBD) patients on transfer to adult health care services. We reviewed the records of IBD patients diagnosed in pediatric care following their transfer/attendance to the adult IBD service. The data on patients who attended the transition service were compared with those who did not pass through the transition service. Seventy-two patients were included in the study 41M and 31F. Forty-four patients went through the transition system (Group A), and 28 had no formalized transition arrangement before transfer (Group B). A significantly higher number of Group B patients needed surgery within 2 years of transfer when compared with patients in Group A (46% vs. 25%, p = .01). Sixty-one percent of patients in Group B needed at least one admission within 2 years of transfer when compared with 29% of Group A patients (p = .002). Nonattendance at clinics was higher in Group B patients with 78% having at least one nonattendance, whereas 29% of Group A failed to attend at least one appointment (p = .001). In addition, drug compliance rates were higher in the transition group when compared with Group B (89% and 46%, respectively; p = .002). A higher proportion of transitioned patients achieved their estimated maximum growth potential when completing adolescence. There was a trend toward higher dependence on opiates and smoking in Group B patients. In adolescent IBD patients, transition care is associated with better disease specific and developmental outcomes. Prospective studies of different models of transition care in IBD are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. Possible addiction transference from cocaine insufflation to oral bupropion in bipolar patient.

    Science.gov (United States)

    Costa, Carolina; Araujo, Alberto; Brasil, Marco; Cruz, Marcelo

    2015-01-01

    Alert for the risk of oral bupropion addiction in patients with cocaine dependence. Single-case study. After a period of cocaine and alcohol abstinence, a 42-year-old patient started taking oral bupropion to relieve the symptoms of cocaine craving. He increased the bupropion dose up to 2250 mg/d without seizures. This case highlights the possibility of oral bupropion addiction after cocaine dependence. To our knowledge, it is the first case in the literature and emphasizes the risk of bupropion's misuse. Therefore, physicians should carefully examine the patient's profile before prescribing it, as well as follow appropriate measures.

  8. The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients.

    Science.gov (United States)

    Karapinar-Carkit, Fatma; Borgsteede, Sander D; Zoer, Jan; Siegert, Carl; van Tulder, Maurits; Egberts, Antoine C G; van den Bemt, Patricia M L A

    2010-02-16

    Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission), insufficient patient information (especially within a multicultural patient population) and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in patients discharged from the internal medicine department. An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient.The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers.The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of life and finally satisfaction of general practitioners

  9. The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare on readmission rates in a multicultural population of internal medicine patients

    Directory of Open Access Journals (Sweden)

    van Tulder Maurits

    2010-02-01

    Full Text Available Abstract Background Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission, insufficient patient information (especially within a multicultural patient population and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare on readmission rates in patients discharged from the internal medicine department. Methods/Design An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient. The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers. The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of

  10. Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia.

    Science.gov (United States)

    Lopez, Derrick; Katzenellenbogen, Judith M; Sanfilippo, Frank M; Woods, John A; Hobbs, Michael S T; Knuiman, Matthew W; Briffa, Tom G; Thompson, Peter L; Thompson, Sandra C

    2014-05-01

    Aboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography. Person-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital. Compared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography. Disparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents

  11. Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers.

    Science.gov (United States)

    Van Arnem, Kerri A; Supinski, David P; Tucker, Jonathan E; Varney, Shawn

    2016-12-01

    Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities. A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury (direct group), transfer from another medical facility (transfer group), computed tomographic scans received, dose-length product, CED of radiation, and injury severity score. A diagnostic imaging physicist then calculated the estimated CED each subject received based on the dose-length product of each computed tomographic scan. A total of 300 patients were analyzed, with 150 patients in the direct group and 150 patients in the transfer group. Both groups were similar in age and sex. Patients in the transfer group received a significantly greater CED of radiation compared with the direct group (mean, 37.6 mSv vs 28 mSv; P=.001). The radiation received in the direct group correlates with a lifetime attributable risk (LAR) of 1 in 357 compared with the transfer group with an increase in LAR to 1 in 266. Patients transferred to our facility received a 34% increase in ionizing radiation compared with patients brought directly from the injury scene. This increased dose of ionizing radiation contributes to the LAR of cancer and needs to be considered before repeating imaging studies. III. Published by Elsevier Inc.

  12. Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

    Science.gov (United States)

    Reime, Marit Hegg; Johnsgaard, Tone; Kvam, Fred Ivan; Aarflot, Morten; Breivik, Marit; Engeberg, Janecke Merethe; Brattebø, Guttorm

    2016-11-01

    Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. High prevalence of lipid transfer protein sensitization in apple allergic patients with systemic symptoms.

    Directory of Open Access Journals (Sweden)

    Francisca Gomez

    Full Text Available Apple allergy manifests as two main groups of clinical entities reflecting different patterns of allergen sensitization: oral allergy syndrome (OAS and generalized symptoms (GS.We analysed the sensitization profile to a wide panel of different components of food allergens (rMal d 1, Mal d 2, rMal d 3, rMal d 4, rPru p 3, rBet v 1 and Pho d 2 for a population of Mediterranean patients with OAS and GS to apple.Patients (N = 81 with a history of apple allergy that could be confirmed by positive prick-prick test and/or double-blind-placebo-controlled food challenge (DBPCFC, were included. Skin prick test (SPT and ELISA were performed using a panel of inhalant, fruit and nut allergens. ELISA and ELISA inhibition studies were performed in order to analyse the sensitization patterns.Thirty-five cases (43.2% had OAS and 46 (56.8% GS. SPT showed a significantly higher number of positive results with peach, cherry and hazelnut in those with GS. ELISA showed a significantly high percentage of positive cases to rMal d 3, rMal d 4, rPru p 3 and Pho d 2 in patients with OAS and GS compared to controls, and to rBet v 1 in patients with OAS vs controls and between OAS and GS patients. Three different patterns of recognition were detected: positive to LTP (rMal d 3 or rPru p 3, positive to profilin (rMal d 4 and Pho d 2, or positive to both. There were also patients with rMal d 1 recognition who showed cross-reactivity to rBet v 1.In an apple allergy population with a high incidence of pollinosis different patterns of sensitization may occur. LTP is most often involved in those with GS. Profilin, though more prevalent in patients with OAS, has been shown to sensitise patients with both types of symptoms.

  14. Patient considerations and clinical impact of cholesteryl ester transfer protein inhibitors in the management of dyslipidemia: focus on anacetrapib

    Directory of Open Access Journals (Sweden)

    Miyares MA

    2012-08-01

    Full Text Available Marta A Miyares, Kyle DavisPharmacy Department, Jackson Memorial Hospital, Miami, FL, USAAbstract: Cardiovascular disease (CVD is responsible for significant morbidity and mortality within the United States and worldwide. Although targeting low-density lipoprotein cholesterol (LDL-C in the prevention of CVD has been shown to be effective, evidence exists to indicate that significant cardiovascular (CV risk remains in patients receiving 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins – a risk that may be correlated with low levels of high-density lipoprotein cholesterol (HDL-C. Among the various tactics under investigation to increase HDL-C, inhibition of cholesteryl ester transfer protein (CETP appears the most adept to raise these levels. Although torcetrapib, a CETP inhibitor, demonstrated significant beneficial changes in HDL-C and LDL-C after 12 months of therapy when coadministered with atorvastatin, patients in the torcetrapib arm experienced a rise in mortality, including increased risk of death from CV and non-CV causes as well as a significant rise in major CV events. Later studies established that the adverse effects of torcetrapib were produced from molecule-specific off-target effects and not to the mechanism of CETP inhibition. These untoward outcomes have not been detected with anacetrapib, the third of the CETP inhibitors to enter Phase III trials. Furthermore, treatment with anacetrapib revealed both a statistically significant decrease in LDL-C and increase in HDL-C over placebo. While the place in therapy of niacin and fibrates to reduce CV events is currently in question secondary to the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes and the Action to Control CV Risk in Diabetes trials, the ongoing large-scale, randomized–placebo, controlled-outcomes study with anacetrapib coadministered with statin treatment will not

  15. Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    Full Text Available Hospital-acquired infections (HAI are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38. When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

  16. Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa.

    Science.gov (United States)

    Fox, Matthew P; Bor, Jacob; Brennan, Alana T; MacLeod, William B; Maskew, Mhairi; Stevens, Wendy S; Carmona, Sergio

    2018-06-01

    Systematic reviews have described high rates of attrition in patients with HIV receiving antiretroviral therapy (ART). However, migration and clinical transfer may lead to an overestimation of attrition (death and loss to follow-up). Using a newly linked national laboratory database in South Africa, we assessed national retention in South Africa's national HIV program. Patients receiving care in South Africa's national HIV program are monitored through regular CD4 count and viral load testing. South Africa's National Health Laboratory Service has maintained a database of all public-sector CD4 count and viral load results since 2004. We linked individual laboratory results to patients using probabilistic matching techniques, creating a national HIV cohort. Validation of our approach in comparison to a manually matched dataset showed 9.0% undermatching and 9.5% overmatching. We analyzed data on patients initiating ART in the public sector from April 1, 2004, to December 31, 2006, when ART initiation could be determined based on first viral load among those whose treatment followed guidelines. Attrition occurred on the date of a patient's last observed laboratory measure, allowing patients to exit and reenter care prior to that date. All patients had 6 potential years of follow-up, with an additional 2 years to have a final laboratory measurement to be retained at 6 years. Data were censored at December 31, 2012. We assessed (a) national retention including all laboratory tests regardless of testing facility and (b) initiating facility retention, where laboratory tests at other facilities were ignored. We followed 55,836 patients initiating ART between 2004 and 2006. At ART initiation, median age was 36 years (IQR: 30-43), median CD4 count was 150 cells/mm3 (IQR: 81-230), and 66.7% were female. Six-year initiating clinic retention was 29.1% (95% CI: 28.7%-29.5%). After allowing for transfers, national 6-year retention was 63.3% (95% CI: 62.9%-63.7%). Results differed

  17. Resistance Analyses of Integrase Strand Transfer Inhibitors within Phase 3 Clinical Trials of Treatment-Naive Patients

    Directory of Open Access Journals (Sweden)

    Kirsten L. White

    2014-07-01

    Full Text Available The integrase (IN strand transfer inhibitors (INSTIs, raltegravir (RAL, elvitegravir (EVG and dolutegravir (DTG, comprise the newest drug class approved for the treatment of HIV-1 infection, which joins the existing classes of reverse transcriptase, protease and binding/entry inhibitors. The efficacy of first-line regimens has attained remarkably high levels, reaching undetectable viral loads in 90% of patients by Week 48; however, there remain patients who require a change in regimen due to adverse events, virologic failure with emergent resistance or other issues of patient management. Large, randomized clinical trials conducted in antiretroviral treatment-naive individuals are required for drug approval in this population in the US, EU and other countries, with the primary endpoint for virologic success at Week 48. However, there are differences in the definition of virologic failure and the evaluation of drug resistance among the trials. This review focuses on the methodology and tabulation of resistance to INSTIs in phase 3 clinical trials of first-line regimens and discusses case studies of resistance.

  18. A risk scoring model based on vital signs and laboratory data predicting transfer to the intensive care unit of patients admitted to gastroenterology wards.

    Science.gov (United States)

    Kim, Won-Young; Lee, Jinmi; Lee, Ju-Ry; Jung, Youn Kyung; Kim, Hwa Jung; Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Hong, Sang-Bum

    2017-08-01

    To compare the ability of a score based on vital signs and laboratory data with that of the modified early warning score (MEWS) to predict ICU transfer of patients with gastrointestinal disorders. Consecutive events triggering medical emergency team activation in adult patients admitted to the gastroenterology wards of the Asan Medical Center were reviewed. Binary logistic regression was used to identify factors predicting transfer to the ICU. Gastrointestinal early warning score (EWS-GI) was calculated as the sum of simplified regression weights (SRW). Of the 1219 included patients, 468 (38%) were transferred to the ICU. Multivariate analysis identified heart rate≥105bpm (SRW 1), respiratory rate≥26bpm (SRW 2), ACDU (Alert, Confused, Drowsy, Unresponsive) score≥1 (SRW 2), SpO 2 /FiO 2 ratiogastroenterology wards. The EWS-GI should be prospectively validated. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Analysis of expiration gas in intensive care patients with SIRS/sepsis using proton-transfer-reaction-mass-spectrometry

    International Nuclear Information System (INIS)

    Bodrogi, F.B.M.

    2003-11-01

    In 1971, Pauling and co-workers were the first to detect volatile organic compounds (VOC) in human breath. Since then, a number of technical applications for breath gas analyses have been designed and processed, among them gas chromatography and proton transfer reaction-mass spectrometry (PTR-MS). Due to this technical progress it is meanwhile possible to correlate different kinds and stages of diseases with measurable changes in the patient's VOC profile. The aim of the present study was to investigate the composition of VOC in exhaled air of patients with sepsis via PTR-MS. To isolate distinct volatile organic compounds that may serve as clinical markers for the onset, the progress, as well as the outcome of the disease, the results obtained from septic patients were compared with two different control groups: 25 healthy, non-smoking volunteers enrolled in the day-case-surgery and 25 post-operative in-patients residing in post-anaesthetic care units (PACU). PTR-MS is capable to analyze VOC according to their molecular weight with a range between 21-230 Da. A total of 210 different masses has been detected in the present study. 54 masses were significantly different in exhaled air of septic patients as compared to healthy controls as well as post-operative patients. Among them, mass 69 representing isoprene might be of special interest for the diagnosis of sepsis. Although no exact biochemical properties of isoprene have been described to date, it is known that isoprene synthesis is increased in plants following exposure to oxidative stress. Chronic, systemic infectious diseases like sepsis are accompanied by the production of reactive oxygen species, indicating that isoprene might be increased in the course of sepsis, too. In the present study, isoprene values were markedly higher in septic patients as compared to PACU residents (3.3-fold increase in mean value) and to healthy volunteers (2.2-fold increase in mean value). In addition (and in contrast to other VOC

  20. Integrated genomic and interfacility patient-transfer data reveal the transmission pathways of multidrug-resistant Klebsiella pneumoniae in a regional outbreak.

    Science.gov (United States)

    Snitkin, Evan S; Won, Sarah; Pirani, Ali; Lapp, Zena; Weinstein, Robert A; Lolans, Karen; Hayden, Mary K

    2017-11-22

    Development of effective strategies to limit the proliferation of multidrug-resistant organisms requires a thorough understanding of how such organisms spread among health care facilities. We sought to uncover the chains of transmission underlying a 2008 U.S. regional outbreak of carbapenem-resistant Klebsiella pneumoniae by performing an integrated analysis of genomic and interfacility patient-transfer data. Genomic analysis yielded a high-resolution transmission network that assigned directionality to regional transmission events and discriminated between intra- and interfacility transmission when epidemiologic data were ambiguous or misleading. Examining the genomic transmission network in the context of interfacility patient transfers (patient-sharing networks) supported the role of patient transfers in driving the outbreak, with genomic analysis revealing that a small subset of patient-transfer events was sufficient to explain regional spread. Further integration of the genomic and patient-sharing networks identified one nursing home as an important bridge facility early in the outbreak-a role that was not apparent from analysis of genomic or patient-transfer data alone. Last, we found that when simulating a real-time regional outbreak, our methodology was able to accurately infer the facility at which patients acquired their infections. This approach has the potential to identify facilities with high rates of intra- or interfacility transmission, data that will be useful for triggering targeted interventions to prevent further spread of multidrug-resistant organisms. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

  1. Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU.

    Science.gov (United States)

    Droogh, Joep M; Kruger, Hanneke L; Ligtenberg, Jack J M; Zijlstra, Jan G

    2012-12-01

    Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a mobile ICU (MICU). Since March 2009 a specially designed MICU and a retrieval team have served the region near University Medical Center Groningen, in the northeastern region of the Netherlands. The MICU transport program includes simulator-based crew resource management (CRM) training for the intensivists and ICU nurses, who, with the drivers, constitute the MICU crews. Training entails five pivotal aspects: (1) preparation, (2) teamwork, (3) new equipment, (4) mobility, and (5) safety. For example, the training accustoms participants to working in the narrow, moving ambulance and without benefit of additional manpower. The scenario-based team training, which takes about four hours, occurs in a training facility, with its reconstructed ICU, and then in the MICU itself. A "wireless" patient simulator that is able to mimic hemodynamic and respiratory patterns and to simulate lung and heart sounds is used. All scenarios can be adjusted to simulate medical, logistic, or technical problems. Since the start of MICU training in 2009, more than 70 training sessions, involving 100 team members, have been conducted. Quality issues identified include failure to anticipate possible problems (such as failing to ask for intubation of a respiratory-compromised patient at intake); late responses to alarms of the ventilator, perfusor pump, or monitor; and not anticipating a possible shortage of medication. Setting up and implementing simulator-based CRM training provides feasible and helpful preparation for an MICU team.

  2. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials

    NARCIS (Netherlands)

    McLernon, D. J.; Harrild, K.; Bergh, C.; Davies, M. J.; de Neubourg, D.; Dumoulin, J. C. M.; Gerris, J.; Kremer, J. A. M.; Martikainen, H.; Mol, B. W.; Norman, R. J.; Thurin-Kjellberg, A.; Tiitinen, A.; van Montfoort, A. P. A.; van Peperstraten, A. M.; van Royen, E.; Bhattacharya, S.

    2010-01-01

    Objective To compare the effectiveness of elective single embryo transfer versus double embryo transfer on the outcomes of live birth, multiple live birth, miscarriage, preterm birth, term singleton birth, and low birth weight after fresh embryo transfer, and on the outcomes of cumulative live birth

  3. A magnetization transfer imaging study of bilateral optic radiation and visual cortex in patients with primary glaucoma

    International Nuclear Information System (INIS)

    Liang Wenwen; Zhang Xuelin; Jiang Xiaoyong; Xu Yongming; Yang Zhihui; Zhang Yan; Chang Renmin; Wang Jianping; Wu Guijun

    2012-01-01

    Objective: To analyse the changes in bilateral optic radiation and visual cortex in patients with primary glaucoma detected by magnetization transfer imaging (MTI), and try to explore the influence of the disease on posterior visual pathway. Methods: MTI was performed in 20 patients with primary glaucoma with normal signal on conventional magnetic resonance imaging (MRI). The same scanning was performed in 31 matched healthy controls. MTI was obtained using spoiled gradient recalled acquisition sequence (SPGR). Magnetization transfer ratio (MTR) of bilateral optic radiation and visual cortex was measured after post-processing. The MTR value differences of the same area between two groups were compared by independent-sample t test or Satterthwaite t test if variances were not equality. Result: The MTR value in the left and right optic radiation were (32.8 ± 2.2)% and (32.7 ± 2.0)% in the glaucoma group, (34.6 ± 1.4 )% and (34.8 ± 1.3)% in the control group. There was a statistically significant difference between the two groups (left t=3.284, right t=4.040; P<0.01). The MTR value of the left and right visual cortex were (30.1± 2.0)% and (30.8 ± 1.8)% in the glaucoma group, and (32.3 ± 1.2 )% and (32.4 ± 1.2)% in the control group. Statistically significant difference was found between the two groups (left t=4.319, right t=3.445; P<0.01). Conclusions: Potential neuropathology changes occurring in the posterior visual pathway of patients with glaucoma indicate that the whole visual pathway may be involved by glaucoma.The micro physiological changes can be detected by MTI which can not be found by conventional MRI. It is a useful method of studying trans-synaptic damage of visual pathway n vivo glaucoma which provides more information for guiding the clinic diagnosis, cure and prognosis of glaucoma. (authors)

  4. Diaphragmatic reinnervation in ventilator-dependent patients with cervical spinal cord injury and concomitant phrenic nerve lesions using simultaneous nerve transfers and implantable neurostimulators.

    Science.gov (United States)

    Kaufman, Matthew R; Elkwood, Andrew I; Aboharb, Farid; Cece, John; Brown, David; Rezzadeh, Kameron; Jarrahy, Reza

    2015-06-01

    Patients who are ventilator dependent as a result of combined cervical spinal cord injury and phrenic nerve lesions are generally considered to be unsuitable candidates for diaphragmatic pacing due to loss of phrenic nerve integrity and denervation of the diaphragm. There is limited data regarding efficacy of simultaneous nerve transfers and diaphragmatic pacemakers in the treatment of this patient population. A retrospective review was conducted of 14 consecutive patients with combined lesions of the cervical spinal cord and phrenic nerves, and with complete ventilator dependence, who were treated with simultaneous microsurgical nerve transfer and implantation of diaphragmatic pacemakers. Parameters of interest included time to recovery of diaphragm electromyographic activity, average time pacing without the ventilator, and percent reduction in ventilator dependence. Recovery of diaphragm electromyographic activity was demonstrated in 13 of 14 (93%) patients. Eight of these 13 (62%) patients achieved sustainable periods (> 1 h/d) of ventilator weaning (mean = 10 h/d [n = 8]). Two patients recovered voluntary control of diaphragmatic activity and regained the capacity for spontaneous respiration. The one patient who did not exhibit diaphragmatic reinnervation remains within 12 months of initial treatment. Surgical intervention resulted in a 25% reduction (p nerve transfers and pacemaker implantation can result in reinnervation of the diaphragm and lead to successful ventilator weaning. Our favorable outcomes support consideration of this surgical method for appropriate patients who would otherwise have no alternative therapy to achieve sustained periods of ventilator independence. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Search and rescue helicopter-assisted transfer of ST-elevation myocardial infarction patients from an island in the Baltic Sea

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Kelbæk, Henning; Pedersen, Frants

    2014-01-01

    BACKGROUND: Since 2005, ST-elevation myocardial infarction (STEMI) patients from the island of Bornholm in the Baltic Sea have been transferred for primary percutaneous coronary intervention (pPCI) by an airborne service. We describe the result of pPCI as part of the Danish national reperfusion s...

  6. Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures.

    Science.gov (United States)

    Overgoor, Max L E; de Jong, Tom P V M; Kon, Moshe

    2014-08-01

    The "TOMAX" (TO MAX-imize sensation, sexuality, and quality of life) procedure restores genital sensation in men with low spinal lesions, improving sexual health, as shown previously. It connects the dorsal nerve of the penis to the intact ipsilateral ilioinguinal nerve, unilaterally or bilaterally. This study reports on the technical aspects based on 43 TOMAX nerve transfers. In 40 patients with no penile but intact groin sensation, 43 nerve transfers were performed. Data on patient selection, surgical history, anatomy of the ilioinguinal nerve and dorsal nerve of the penis, unilateral or bilateral surgery, surgical technique, complications, and patient information were collected prospectively. Regardless of origin, all patients with no penile but good groin sensation are eligible for the procedure, provided the ilioinguinal nerve is not damaged because of former inguinal surgery or absent because of anatomical variations. Selection of a unilateral or bilateral procedure depends on the presence or absence of reflex erections and bulbocavernosus reflex. Preliminary experience with the first three bilateral cases shows that it is technically feasible, with encouraging results. The surgical technique has evolved (described in detail, including video) to enhance outcome and reduce complications. Patients are better informed, resulting in realistic expectations. This article synthesizes the procedural and technical experience of 43 TOMAX nerve transfers. Anyone skilled in peripheral nerve surgery and microsurgery can adopt this concept and further develop it. The TOMAX procedure can then be used to restore erogenous penile sensation and improve the quality of sexual health in patients with absent penile but good groin sensation.

  7. Level of training and experience in physicians performing interhospital transfers of adult patients in the internal medicine department

    DEFF Research Database (Denmark)

    Hallas, P; Folkestad, L; Brabrand, M

    2009-01-01

    AIM: To establish the level of training doctors who participate in interhospital transfers in Denmark. METHODS: A questionnaire was sent to every hospital department in Denmark with acute internal medicine admissions. RESULTS: Eighty-nine internal medicine departments were contacted and 84...... responded (response rate 94.4%). Of the 84 hospitals, 75 (89.3%) indicated that they perform interhospital transfers. Most transfers were performed by interns (61.3%) or senior house officers (10.7%) with only a few months' experience in their current speciality. Training in interhospital transfer...

  8. Lipid transfers to HDL are diminished in long-term bedridden patients: association with low HDL-cholesterol and increased inflammatory markers.

    Science.gov (United States)

    de Oliveira, Wilson Pascoalino Camargo; Tavoni, Thauany Martins; Freitas, Fatima Rodrigues; Silva, Bruna Miranda Oliveira; Maranhão, Raul Cavalcante

    2017-08-01

    Plasma lipids have been extensively studied in sedentary and in subjects practicing exercise training, but not in extreme inactivity as occurs in bedridden patients. This is important for the care of bedridden patients and understanding the overall plasma lipid regulation. Here, we investigated plasma lipids, lipid transfers to HDL and inflammatory markers in bedridden patients. Fasting blood samples were collected from 23 clinically stable bedridden patients under long-term care (>90 days) and 26 normolipidemic sedentary subjects, paired for age and gender. In vitro transfer of four lipids to HDL was performed by incubating plasma with donor nanoparticles containing radioactive lipids. Total (193 ± 36 vs 160 ± 43, p = 0.005), LDL (124 ± 3 vs 96 ± 33 p = 0.003) and HDL-cholesterol (45 ± 10 vs 36 ± 13, p = 0.008), apolipoprotein A-I (134 ± 20 vs 111 ± 24, p = 0.001) and oxidized LDL (53 ± 13 vs 43 ± 12, p = 0.011) were lower in bedridden patients, whereas triglycerides, apolipoprotein B, CETP and LCAT were equal in both groups. Transfers of all lipids, namely unesterified cholesterol, cholesterol esters, triglycerides and phospholipids, to HDL were lower in bedridden patients, probably due to their lower HDL-cholesterol levels. Concentrations of IL-1β, IL-6, IL-8, HGF and NGF were higher in bedridden patients compared to sedentary subjects. In conclusion, inactivity had great impact on HDL, by lowering HDL-cholesterol, apolipoprotein A-I and thereby cholesterol transfers to the lipoprotein, which suggests that inactivity may deteriorate HDL protection beyond the ordinary sedentary condition.

  9. Comprehensive approach to functional palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients.

    Science.gov (United States)

    Urken, Mark L; Roche, Ansley M; Kiplagat, Kimberly J; Dewey, Eliza H; Lazarus, Cathy; Likhterov, Ilya; Buchbinder, Daniel; Okay, Devin J

    2018-03-14

    Palatomaxillary defects were historically restored with a prosthetic obturator; however, advances in local and free tissue transfer has provided a viable alternative for appropriately selected patients with palatomaxillary defects. A retrospective chart review of patients who underwent palatomaxillary reconstruction by the lead author between 1998 and 2016 was conducted. Patients who were restored with a palatal obturator were excluded. One hundred forty patients were reconstructed with a total of 159 local, regional, and free flaps with a 96.7% success rate. Seventy-four patients (52.8%) underwent prosthodontic rehabilitation, with 183 implants placed and an 86% success rate. Palatomaxillary reconstruction applying a systematic approach, using a multitude of techniques, is a safe and effective way to restore patients without compromising the ability to maintain surveillance. Prosthodontic rehabilitation can be achieved in a high percentage of patients using dental implants, leading to optimal aesthetic and functional results. © 2018 Wiley Periodicals, Inc.

  10. Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer

    DEFF Research Database (Denmark)

    Iachina, Maria; Jakobsen, Erik; Fallesen, Anne Kudsk

    2017-01-01

    with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis......BACKGROUND: Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested...... and incomplete data on the dates of referral, diagnosis and treatment were excluded. RESULTS: A total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68-0.96)) and in total time from referral to treatment (HR 0...

  11. Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer: a resting-state fMRI study

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Aihong; Cheng, Xiaoguang; Liang, Wei; Bai, Rongjie [The 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Xicheng Qu, Beijing (China); Wang, Shufeng; Xue, Yunhao; Li, Wenjun [The 4th Medical College of Peking University, Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing (China)

    2017-03-15

    The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex. (orig.)

  12. Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer: a resting-state fMRI study

    International Nuclear Information System (INIS)

    Yu, Aihong; Cheng, Xiaoguang; Liang, Wei; Bai, Rongjie; Wang, Shufeng; Xue, Yunhao; Li, Wenjun

    2017-01-01

    The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex. (orig.)

  13. Active surveillance for asymptomatic colonisation by multidrug-resistant bacteria in patients transferred to a tertiary care hospital in the occupied Palestinian territory.

    Science.gov (United States)

    Taha, Adham Abu; Daoud, Ayman; Zaid, Sawsan; Sammour, Sajida; Belleh, Maram; Daifi, Refqa

    2018-02-21

    Active surveillance is important in infection control programmes, allowing the detection of patients colonised with multi-drug resistant organisms and preventing the spread of multi-drug resistant organisms. The aim of this study was to determine the rate of asymptomatic colonisation with multi-drug resistant organisms and the prevalence of each organism in patients transferred to An-Najah National University Hospital, Nablus, occupied Palestinian territory. Patients transferred from other hospitals between January and December, 2015, were screened at time of admission by taking nasal, groin, and axillary swabs. Swabs were cultured and assessed for the presence of multi-drug resistant organisms (extended spectrum β-lactamase producers, Pseudomonas aeroginosae, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, and carbapenem-resistant enterobacteriaceae. Of the 822 screened patients, 265 (32%) had infections with multi-drug resistant organisms. 394 isolates of multi-drug resistant organisms were obtained: 131 (33%) isolates were extended spectrum β-lactamase producers, 119 (30%) isolates were P aeroginosae, 26 (9%) isolates were A baumannii, 94 (24%) isolates were methicillin-resistant S aureus, 13 (3%) isolates were vancomycin-resistant enterococci, and one (<1%) isolate was carbapenem-resistant enterobacteriaceae. We identified a high prevalence of asymptomatic colonisation with multidrug-resistant bacteria in transferred patients. These findings emphasise the need for a national strategy to combat the spread of multi-drug resistant organisms in the occupied Palestinian territory. An-Najah National University. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. S1 nuclease analysis of α-globin gene expression in preleukemic patients with acquired hemoglobin H disease after transfer to mouse erythroleukemia cells

    International Nuclear Information System (INIS)

    Helder, J.; Deisseroth, A.

    1987-01-01

    The loss of α-globin gene transcriptional activity rarely occurs as an acquired abnormality during the evolution of myeloproliferative disease or preleukemia. To test whether the mutation responsible for the loss of α-globin gene expression (hemoglobin H disease) in these patients is linked with the α-globin genes on chromosome 16, the authors transferred chromosome 16 from preleukemic patients with acquired hemoglobin H disease to mouse erythroleukemia cells and measured the transcriptional activity of the human α-globin genes. After transfer to mouse erythroleukemia cells, the expression of human α-globin genes from the peripheral blood or marrow cells of preleukemic patients with acquired hemoglobin H disease was similar to that of human α-globin genes transferred to mouse erythroleukemia cells from normal donors. These data showed that factor(s) in the mouse erythroleukemia cell can genetically complement the α-globin gene defect in these preleukemia patients with acquired hemoglobin H disease and suggest that altered expression of a gene in trans to the α-globin gene may be responsible for the acquisition of hemoglobin H disease in these patients

  15. Factor IX expression in skeletal muscle of a severe hemophilia B patient 10 years after AAV-mediated gene transfer.

    Science.gov (United States)

    Buchlis, George; Podsakoff, Gregory M; Radu, Antonetta; Hawk, Sarah M; Flake, Alan W; Mingozzi, Federico; High, Katherine A

    2012-03-29

    In previous work we transferred a human factor IX-encoding adeno-associated viral vector (AAV) into skeletal muscle of men with severe hemophilia B. Biopsy of injected muscle up to 1 year after vector injection showed evidence of gene transfer by Southern blot and of protein expression by IHC and immunofluorescent staining. Although the procedure appeared safe, circulating F.IX levels remained subtherapeutic (< 1%). Recently, we obtained muscle tissue from a subject injected 10 years earlier who died of causes unrelated to gene transfer. Using Western blot, IHC, and immunofluorescent staining, we show persistent factor IX expression in injected muscle tissue. F.IX transcripts were detected in injected skeletal muscle using RT-PCR, and isolated whole genomic DNA tested positive for the presence of the transferred AAV vector sequence. This is the longest reported transgene expression to date from a parenterally administered AAV vector, with broad implications for the future of muscle-directed gene transfer.

  16. A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

    Science.gov (United States)

    Lee, Seul; Oh, HyunSoo; Suh, YeonOk; Seo, WhaSook

    2017-03-01

    To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress

  17. Advanced scheduling for zygote intrafallopian transfer is possible via the use of a hormone replacement cycle for patients who have experienced repeated implantation failures.

    Science.gov (United States)

    Nakagawa, Koji; Juen, Hiroyasu; Nishi, Yayoi; Sugiyama, Rie; Motoyama, Hiroshi; Kuribayashi, Yasushi; Inoue, Masato; Akira, Shigeo; Sugiyama, Rikikazu

    2014-11-01

    Zygote intrafallopian transfer (ZIFT) is an effective option for patients who have experienced repeated implantation failures (RIF) in assisted reproductive technology (ART) treatment. However, advance planning for the day of the operation can be problematic. Using a hormone replacement cycle (HRC) makes it possible to plan for the day of ZIFT. In the present study, we evaluated whether HRC-ZIFT is useful for RIF patients who have experienced difficulties obtaining morphologically good embryos in vitro. A total of 55 patients with a history of five or more unsuccessful transfers received HRC-ZIFT between June 2008 and June 2013. The oocyte pick-ups were performed and the oocytes showing two pronuclei (2PN) were cryopreserved. After receiving more than five 2PN oocytes, the operation day was scheduled in advance, and as a consequence, a HRC was started and ZIFT was performed. The clinical outcomes were evaluated. The average age of the patients was 39.3 years, and the previous OPU and ET attempts numbered 7.5 and 6.9, respectively. The number of previously transferred embryos was 11.8, and the number of morphologically good embryos (MGEs) was only 1.2. The number of transferred 2PN oocytes was 6.7, and the subsequent pregnancy rate was 23.6 %. No ectopic or multiple pregnancies were observed, but there were 6 cases of miscarriage. Among RIF patients, in particular those who have difficulty obtaining MGEs in vitro, ZIFT might be a useful option. The HRC allows patients and medical staff to plan for the operation day in advance.

  18. Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project.

    Science.gov (United States)

    Ersek, Mary; Hickman, Susan E; Thomas, Anne C; Bernard, Brittany; Unroe, Kathleen T

    2017-10-17

    The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  19. A quantitative study of ramped radio frequency, magnetization transfer, and slab thickness in three-dimensional time-of-flight magnetic resonance angiography in a patient population.

    Science.gov (United States)

    Goodrich, K C; Blatter, D D; Parker, D L; Du, Y P; Meyer, K J; Bernstein, M A

    1996-06-01

    The authors compare the effectiveness of various magnetic resonance (MR) angiography acquisition strategies in enhancing the visibility of small intracranial vessels. Blood vessel contrast-to-noise ratio (CNR) in time-of-flight MR angiography was studied as a function of vessel size and several selectable imaging parameters. Contrast-to-noise measurements were made on 257 vessel segments ranging in size from 0.3 mm to 4.2 mm in patients who recently had undergone intraarterial cerebral angiography. Imaging parameters studied included magnetization transfer, spatially variable radio frequency (RF) pulse profile (ramped RF), and imaging slab thickness. The combination of thin slabs (16 slices/slab), ramped RF, and magnetization transfer resulted in the highest CNR for all but the smallest vessel sizes. The smallest vessels (slab (64 slices/slab) with ramped RF and magnetization transfer. Magnetization transfer always improved vessel CNR, but the improvement diminished as the slab thickness was reduced. The CNR increased with a decrease in slab thickness for all but the smallest vessel sizes. Overall, the results provide a quantitative demonstration that inflow enhancement of blood is reduced for small vessels. Thus, whereas magnetization transfer is important at all vessel sizes, it becomes the primary factor in improving the visibility of the smallest vessels.

  20. Special article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.

    Science.gov (United States)

    Larach, Marilyn Green; Dirksen, Sharon J Hirshey; Belani, Kumar G; Brandom, Barbara W; Metz, Keith M; Policastro, Michael A; Rosenberg, Henry; Valedon, Arnaldo; Watson, Charles B

    2012-01-01

    Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.

  1. Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013.

    Science.gov (United States)

    Mersereau, Jennifer; Stanhiser, Jamie; Coddington, Charles; Jones, Tiffany; Luke, Barbara; Brown, Morton B

    2017-11-01

    To analyze factors associated with high live birth rate and low multiple birth rate in fresh and frozen-thawed assisted reproductive technology (ART) cycles. Retrospective cohort analysis. Not applicable. The study population included 181,523 women undergoing in vitro fertilization with autologous fresh first cycles, 27,033 with fresh first oocyte donor cycles, 37,658 with fresh second cycles, and 35,446 with frozen-thawed second cycles. None. Live birth rate and multiple birth rate after single-embryo transfer (SET) and double embryo transfer (DET) were measured, in addition to cycle characteristics. In patients with favorable prognostic factors, including younger maternal age, transfer of a blastocyst, and additional embryos cryopreserved, the gain in the live birth rate from SET to DET was approximately 10%-15%; however, the multiple birth rate increased from approximately 2% to greater than 49% in both autologous and donor fresh and frozen-thawed transfer cycles. This study reports a 10%-15% reduction in live birth rate and a 47% decrement in multiple birth rate with SET compared with DET in the setting of favorable patient prognostic factors. Our findings present an opportunity to increase the rate of SET across the United States and thereby reduce the multiple birth rate and its associated poor perinatal outcomes with assisted reproductive technology pregnancies. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Factor IX expression in skeletal muscle of a severe hemophilia B patient 10 years after AAV-mediated gene transfer

    OpenAIRE

    Buchlis, George; Podsakoff, Gregory M.; Radu, Antonetta; Hawk, Sarah M.; Flake, Alan W.; Mingozzi, Federico; High, Katherine A.

    2012-01-01

    In previous work we transferred a human factor IX–encoding adeno-associated viral vector (AAV) into skeletal muscle of men with severe hemophilia B. Biopsy of injected muscle up to 1 year after vector injection showed evidence of gene transfer by Southern blot and of protein expression by IHC and immunofluorescent staining. Although the procedure appeared safe, circulating F.IX levels remained subtherapeutic (< 1%). Recently, we obtained muscle tissue from a subject injected 10 years earlier ...

  3. Cholesteryl Ester Transfer Protein Intimately Involved in Dyslipidemia-Related Susceptibility to Cognitive Deficits in Type 2 Diabetic Patients.

    Science.gov (United States)

    Sun, Jie; Cai, Rongrong; Huang, Rong; Wang, Pin; Tian, Sai; Sun, Haixia; Xia, Wenqing; Wang, Shaohua

    2016-08-01

    Cholesteryl ester transfer protein (CETP) is involved in diabetic dyslipidemia. We aim to test the hypothesis that CETP might be of importance in mediating dyslipidemia-related susceptibility to cognitive deficits in diabetic patients. We recruited 190 type 2 diabetic patients and divided them into two groups according to the Montreal Cognitive Assessment (MoCA) score. The association between CETP and cognitive decline was analyzed with logistic regression and stratification. There were 110 diabetic patients with mild cognition impairment (MCI) and 80 healthy cognition subjects as controls. Dyslipidemia is more common among diabetic patients with MCI; they had a significant increase of serum CETP concentrations, which was negatively correlated with MoCA (r = -0.638; p dyslipidemia-related susceptibility to cognitive decline, especially memory function in type 2 diabetic patients.

  4. Multicomponent Exercise Improves Hemodynamic Parameters and Mobility, but Not Maximal Walking Speed, Transfer Capacity, and Executive Function of Older Type II Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Hélio José Coelho Junior

    2018-01-01

    Full Text Available The present study aimed to investigate the effects of a 6-month multicomponent exercise program (MCEP on functional, cognitive, and hemodynamic parameters of older Type 2 diabetes mellitus (T2DM patients. Moreover, additional analyses were performed to evaluate if T2DM patients present impaired adaptability in response to physical exercise when compared to nondiabetic volunteers. A total of 72 T2DM patients and 72 age-matched healthy volunteers (CG were recruited and submitted to functional, cognitive, and hemodynamic evaluations before and after six months of a MCEP. The program of exercise was performed twice a week at moderate intensity. Results indicate T2DM and nondiabetic patients present an increase in mobility (i.e., usual walking speed after the MCEP. However, improvements in maximal walking speed, transfer capacity, and executive function were only observed in the CG. On the other hand, only T2DM group reveals a marked decline in blood pressure. In conclusion, data of the current study indicate that a 6-month MCEP improves mobility and reduce blood pressure in T2DM patients. However, maximal walking speed, transfer capacity, and executive function were only improved in CG, indicating that T2DM may present impaired adaptability in response to physical stimulus.

  5. [Countertransference in homoerotic transference].

    Science.gov (United States)

    Junkert-Tress, B; Reister, G

    1995-01-01

    Until now psychoanalytic training and literature have hardly considered the transference love of homosexual patients. We summarized the scarce literature and related it to the background of our knowledge of heterosexual transference love. The discussion leaves no doubt that, like the heterosexual, homosexual transference love must be read on all levels of psychosexual development instead of reading it on only one and definitely not on an amorphous "preoedipal" level. This is particularly true for the level of the adult homosexual patient, as the case history demonstrates.

  6. Quantitative Approach Based on Wearable Inertial Sensors to Assess and Identify Motion and Errors in Techniques Used during Training of Transfers of Simulated c-Spine-Injured Patients

    Directory of Open Access Journals (Sweden)

    Karina Lebel

    2018-01-01

    Full Text Available Patients with suspected spinal cord injuries undergo numerous transfers throughout treatment and care. Effective c-spine stabilization is crucial to minimize the impacts of the suspected injury. Healthcare professionals are trained to perform those transfers using simulation; however, the feedback on the manoeuvre is subjective. This paper proposes a quantitative approach to measure the efficacy of the c-spine stabilization and provide objective feedback during training. Methods. 3D wearable motion sensors are positioned on a simulated patient to capture the motion of the head and trunk during a training scenario. Spatial and temporal indicators associated with the motion can then be derived from the signals. The approach was developed and tested on data obtained from 21 paramedics performing the log-roll, a transfer technique commonly performed during prehospital and hospital care. Results. In this scenario, 55% of the c-spine motion could be explained by the difficulty of rescuers to maintain head and trunk alignment during the rotation part of the log-roll and their difficulty to initiate specific phases of the motion synchronously. Conclusion. The proposed quantitative approach has the potential to be used for personalized feedback during training sessions and could even be embedded into simulation mannequins to provide an innovative training solution.

  7. Short- and long-term transfer of urethral catheterization skills from simulation training to performance on patients

    DEFF Research Database (Denmark)

    Todsen, Tobias; Henriksen, Mikael V.; Kromann, Charles B.

    2013-01-01

    Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC...

  8. Primary resistance to integrase strand transfer inhibitors in patients infected with diverse HIV-1 subtypes in sub-Saharan Africa

    NARCIS (Netherlands)

    Inzaule, Seth C.; Hamers, Raph L.; Noguera-Julian, Marc; Casadellà, Maria; Parera, Mariona; Rinke de Wit, Tobias F.; Paredes, Roger

    2018-01-01

    To investigate the prevalence and patterns of major and accessory resistance mutations associated with integrase strand transfer inhibitors (INSTIs), across diverse HIV-1 subtypes in sub-Saharan Africa. pol gene sequences were obtained using Illumina next-generation sequencing from 425 INSTI-naive

  9. Heat transfer

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Heat transfer. Heat conduction in solid slab. Convective heat transfer. Non-linear temperature. variation due to flow. HEAT FLUX AT SURFACE. conduction/diffusion.

  10. Heat transfer

    International Nuclear Information System (INIS)

    Saad, M.A.

    1985-01-01

    Heat transfer takes place between material systems as a result of a temperature difference. The transmission process involves energy conversions governed by the first and second laws of thermodynamics. The heat transfer proceeds from a high-temperature region to a low-temperature region, and because of the finite thermal potential, there is an increase in entropy. Thermodynamics, however, is concerned with equilibrium states, which includes thermal equilibrium, irrespective of the time necessary to attain these equilibrium states. But heat transfer is a result of thermal nonequilibrium conditions, therefore, the laws of thermodynamics alone cannot describe completely the heat transfer process. In practice, most engineering problems are concerned with the rate of heat transfer rather than the quantity of heat being transferred. Resort then is directed to the particular laws governing the transfer of heat. There are three distinct modes of heat transfer: conduction, convection, and radiation. Although these modes are discussed separately, all three types may occur simultaneously

  11. Transfer Pricing

    DEFF Research Database (Denmark)

    Nielsen, Søren Bo

    2014-01-01

    Against a background of rather mixed evidence about transfer pricing practices in multinational enterprises (MNEs) and varying attitudes on the part of tax authorities, this paper explores how multiple aims in transfer pricing can be pursued across four different transfer pricing regimes. A MNE h...

  12. Consequences of increased use of computed tomography imaging for trauma patients in rural referring hospitals prior to transfer to a regional trauma centre.

    Science.gov (United States)

    Berkseth, Timothy J; Mathiason, Michelle A; Jafari, Mary Ellen; Cogbill, Thomas H; Patel, Nirav Y

    2014-05-01

    Computed tomography (CT) plays an integral role in the evaluation and management of trauma patients. As the number of referring hospital (RH)-based CT scanners increased, so has their utilization in trauma patients before transfer. We hypothesized that this has resulted in increased time at RH, image duplication, and radiation dose. A retrospective chart review was completed for trauma activations transferred to an ACS-verified Level II Trauma Centre (TC) during two time periods: 2002-2004 (Group 1) and 2006-2008 (Group 2). 2005 data were excluded as this marked the transition period for acquisition of hospital-based CT scanners in RH. Statistical analysis included t test and χ(2) analysis. Pgroup 1 and 514 in group 2. Mean age was greater in group 2 compared to group 1 (40.3 versus 37.4, respectively; P=0.028). There were 115 patients in group 1 versus 202 patients in group 2 who underwent CT imaging at RH (Pgroup 1 had CT scans performed at the TC versus 258 patients in group 2 (Ptime at the RH was similar between the groups (117.1 and 112.3min for group 1 and 2, respectively; P=0.561). However, when comparing patients with and without a pretransfer CT at the RH, the median time at RH was 140 versus 67min, respectively (Pgroup 1 and n=42 in group 2) was not significantly different between the two time periods (P=0.392). Head CTs comprised the majority of duplicate CT imaging in both time periods (82.4% in group 1 and 90.5% in group 2). Mean total estimated radiation dose per patient was not significantly different between the two groups (group 1=8.4mSv versus group 2=7.8mSv; P=0.192). A significant increase in CT imaging at the RH prior to transfer to the TC was observed over the study periods. No associated increases in mean time at the RH, image duplication at TC, total estimated radiation dose per patient, and mortality rate were observed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Does preoperative abduction value affect functional outcome of combined muscle transfer and release procedures in obstetrical palsy patients with shoulder involvement?

    Directory of Open Access Journals (Sweden)

    Onel Defne

    2004-08-01

    Full Text Available Abstract Background Obstetric palsy is the injury of the brachial plexus during delivery. Although many infants with plexopathy recover with minor or no residual functional deficits, some children don't regain sufficient limb function because of functional limitations, bony deformities and joint contractures. Shoulder is the most frequently affected joint with internal rotation contracture causing limitation of abduction, external rotation. The treatment comprises muscle release procedures such as posterior subscapularis sliding or anterior subscapularis tendon lengtening and muscle transfers to restore the missing external rotation and abduction function. Methods We evaluated whether the preoperative abduction degree affects functional outcome. Between 1998 and 2002, 46 children were operated on to restore shoulder abduction and external rotation. The average age at surgery was 7.6 years and average follow up was 40.8 months. We compared the postoperative results of the patients who had preoperative abduction less than 90° (Group I: n = 37 with the patients who had preoperative abduction greater than 90° (Group II: n = 9, in terms of abduction and external rotation function with angle measurements and Mallet classification. We inquired whether patients in Group I needed another muscle transfer along with latissimus dorsi and teres major transfers. Results In Group I the average abduction improved from 62.5° to 131.4° (a 68.9° ± 22.9°gain and the average external rotation improved from 21.4° to 82.6° (a 61.1° ± 23°gain. In Group II the average abduction improved from 99.4°to 140°(a40.5° ± 16°gain and the average external rotation improved from 33.2°to 82.7° (a 49.5° ± 23.9° gain. Although there was a significant difference between Group I and II for preoperative abduction (p = 0.000 and abduction gain in degrees (p = 0.001, the difference between postoperative values of both groups was not significant (p = 0.268. There was

  14. Patient safety during assistant propelled wheelchair transfers: the effect of the seat cushion on risk of falling.

    Science.gov (United States)

    Okunribido, Olanrewaju O

    2013-01-01

    This article is a report of a study of the effect of the seat cushion on risk of falling from a wheelchair. Two laboratory studies and simulated assistant propelled wheelchair transfers were conducted with four healthy female participants. For the laboratory studies there were three independent variables: trunk posture (upright/flexed forward), seat cushion (flat polyurethane/propad low profile), and feet condition (dangling/supported), and two dependent variables: occupied wheelchair (wheelchair) center of gravity (CG), and stability. For the simulated transfers there was one independent variable: seat cushion (flat polyurethane/propad low profile), and one dependent variable: perception of safety (risk of falling). Results showed that the wheelchair CG was closer to the front wheels, and stability lower for the propad low profile cushion compared to the polyurethane cushion, when the participants sat with their feet dangling. During the simulated transfers, sitting on the propad low profile cushion caused participants to feel more apprehensive (anxious or uneasy) compared to sitting on the polyurethane cushion. The findings can contribute to the assessment of risk and care planning of non-ambulatory wheelchair users.

  15. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

    Directory of Open Access Journals (Sweden)

    Yang Zhihong

    2012-05-01

    Full Text Available Abstract Background Single embryo transfer (SET remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH to provide this advantage and improve pregnancy rate from SET. Methods First-time IVF patients with a good prognosis (age Results For patients in Group A (n = 55, 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient. Aneuploidy was detected in 191/425 (44.9% of blastocysts in this group. For patients in Group B (n = 48, 389 blastocysts were microscopically examined (8.1 blastocysts/patient. Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017; ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009. There were no twin pregnancies. Conclusion Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss, this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9% among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

  16. Transfer Pricing

    DEFF Research Database (Denmark)

    Rohde, Carsten; Rossing, Christian Plesner

    trade internally as the units have to decide what prices should be paid for such inter-unit transfers. One important challenge is to uncover the consequences that different transfer prices have on the willingness in the organizational units to coordinate activities and trade internally. At the same time...... the determination of transfer price will affect the size of the profit or loss in the organizational units and thus have an impact on the evaluation of managers‟ performance. In some instances the determination of transfer prices may lead to a disagreement between coordination of the organizational units...

  17. Exosomes isolated from cancer patients' sera transfer malignant traits and confer the same phenotype of primary tumors to oncosuppressor-mutated cells.

    Science.gov (United States)

    Abdouh, Mohamed; Hamam, Dana; Gao, Zu-Hua; Arena, Vincenzo; Arena, Manuel; Arena, Goffredo Orazio

    2017-08-30

    Horizontal transfer of malignant traits from the primary tumor to distant organs, through blood circulating factors, has recently become a thoroughly studied metastatic pathway to explain cancer dissemination. Recently, we reported that oncosuppressor gene-mutated human cells undergo malignant transformation when exposed to cancer patients' sera. We also observed that oncosuppressor mutated cells would show an increased uptake of cancer-derived exosomes and we suggested that oncosuppressor genes might protect the integrity of the cell genome by blocking integration of cancer-derived exosomes. In the present study, we tested the hypothesis that cancer patients' sera-derived exosomes might be responsible for the malignant transformation of target cells and that oncosuppressor mutation would promote their increased uptake. We also sought to unveil the mechanisms behind the hypothesized phenomena. We used human BRCA1 knockout (BRCA1-KO) fibroblasts as target cells. Cells were treated in vitro with cancer patients' sera or cancer patients' sera-derived exosomes. Treated cells were injected into NOD-SCID mice. Immunohistochemical analyses were performed to determine the differentiation state of the xenotransplants. Mass spectrometry analyses of proteins from cancer exosomes and the BRCA1-KO fibroblasts' membrane were performed to investigate possible de novo expression of molecules involved in vesicles uptake. Blocking of the identified molecules in vitro was performed and in vivo experiments were conducted to confirm the role of these molecules in the malignant transformation carried out by cancer-derived exosomes. Cells treated with exosomes isolated from cancer patients' sera underwent malignant transformation and formed tumors when transplanted into immunodeficient mice. Histological analyses showed that the tumors were carcinomas that differentiated into the same lineage of the primary tumors of blood donors. Oncosuppressor mutation promoted the de novo expression

  18. A Randomized Trial to Evaluate the Effect of Local Endometrial Injury on the Clinical Pregnancy Rate of Frozen Embryo Transfer Cycles in Patients With Repeated Implantation Failure

    Directory of Open Access Journals (Sweden)

    Ensieh Shahrokh-Tehraninejad

    2016-12-01

    Full Text Available Objective: Repeated implantation failure (RIF is a condition in which the embryos implantation decreases in the endometrium. So, our aim was to evaluate the effect of local endometrial injury on embryo transfer results.Materials and methods: In this simple randomized clinical trial (RCT, a total of 120 patients were selected. The participants were less than 40 years old, and they are in their minimum two cycles of vitro fertilization (IVF. Patients were divided randomly into two groups of LEI (Local endometrial injury and a control group (n = 60 in each group. The first group had four small endometrial injuries from anterior, posterior, and lateral uterus walls which were obtained from people who were in 21th day of their previous IVF cycle. The second group was the patients who have not received any intervention.Results: The experimental and control patients were matched in the following factors. Regarding the clinical pregnancy rate, there was no significant difference noted between the experimental and the control group.Conclusion: Local endometrial injury in a preceding cycle does not increase the clinical pregnancy rate in the subsequent FET cycle of patients with repeated implantation failure.

  19. Modified hMG stimulated: an effective option in endometrial preparation for frozen-thawed embryo transfer in patients with normal menstrual cycles.

    Science.gov (United States)

    Huang, Pinxiu; Wei, Lihong; Li, Xinlin; Lin, Zhong

    2018-04-20

    To evaluate the clinical efficacy of modified human menopausal gonadotropin (hMG) stimulated, hormone replacement therapy (HRT), natural cycling and letrozole ovulation induction during endometrial preparation for frozen-thawed embryo transfer (FET) in patients with normal menstrual cycles. This retrospective analysis included a total of 5070 cycles of patients with normal menstrual patterns who underwent FET between October 2009 and September 2015. The patients were divided into four groups according to the method of endometrial preparation for FET: 1838 cycles were natural, 1666 underwent HRT, 340 underwent letrozole ovulation induction and 1226 underwent modified hMG stimulated. Reproduction-related clinical outcomes in the four groups were compared. The clinical pregnancy rates and live birth rates of patients in the modified hMG stimulated group were significantly higher than that in the other groups p .05). Modified hMG stimulated resulted in a higher pregnancy rate compared to the other treatment groups. Therefore, modified hMG stimulated may be an effective option in endometrial preparation for FET in patients with normal menstrual cycles.

  20. Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients.

    Science.gov (United States)

    Singh, Savita; Soni, Ritu; Singh, K P; Tandon, O P

    2012-01-01

    Prana is the energy, when the self-energizing force embraces the body with extension and expansion and control, it is pranayama. It may affect the milieu at the bronchioles and the alveoli particularly at the alveolo-capillary membrane to facilitate diffusion and transport of gases. It may also increase oxygenation at tissue level. Aim of our study is to compare pulmonary functions and diffusion capacity in patients of bronchial asthma before and after yogic intervention of 2 months. Sixty stable asthmatic-patients were randomized into two groups i.e group 1 (Yoga training group) and group 2 (control group). Each group included thirty patients. Lung functions were recorded on all patients at baseline, and then after two months. Group 1 subjects showed a statistically significant improvement (Pincreased significantly. It was concluded that pranayama & yoga breathing and stretching postures are used to increase respiratory stamina, relax the chest muscles, expand the lungs, raise energy levels, and calm the body.

  1. Human chorionic gonadotropin-administered natural cycle versus spontaneous ovulatory cycle in patients undergoing two pronuclear zygote frozen-thawed embryo transfer.

    Science.gov (United States)

    Lee, You-Jung; Kim, Chung-Hoon; Kim, Do-Young; Ahn, Jun-Woo; Kim, Sung-Hoon; Chae, Hee-Dong; Kang, Byung-Moon

    2018-03-01

    To compare human chorionic gonadotropin (HCG)-administered natural cycle with spontaneous ovulatory cycle in patients undergoing frozen-thawed embryo transfer (FTET) in natural cycles. In this retrospective cohort study, we analyzed the clinical outcome of a total of 166 consecutive FTET cycles that were performed in either natural cycle controlled by HCG for ovulation triggering (HCG group, n=110) or natural cycle with spontaneous ovulation (control group, n=56) in 166 infertile patients between January 2009 and November 2013. There were no differences in patients' characteristics between the 2 groups. The numbers of oocytes retrieved, mature oocytes, fertilized oocytes, grade I or II embryos and frozen embryos in the previous in vitro fertilization (IVF) cycle in which embryos were frozen were comparable between the HCG and control groups. Significant differences were not also observed between the 2 groups in clinical pregnancy rate (CPR), embryo implantation rate, miscarriage rate, live birth rate and multiple CPR. However, the number of hospital visits for follicular monitoring was significantly fewer in the HCG group than in the control group ( P cycle reduces the number of hospital visits for follicular monitoring without any detrimental effect on FTET outcome when compared with spontaneous ovulatory cycles in infertile patients undergoing FTET in natural ovulatory cycles.

  2. "Transfer Shock" or "Transfer Ecstasy?"

    Science.gov (United States)

    Nickens, John M.

    The alleged characteristic drop in grade point average (GPA) of transfer students and the subsequent rise in GPA was investigated in this study. No statistically significant difference was found in first term junior year GPA between junior college transfers and native Florida State University students after the variance accounted for by the…

  3. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.

    Science.gov (United States)

    Chen, Chien-Min; Ke, Yen-Liang

    2016-02-01

    One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.

  4. Therapeutic hemoglobin levels after gene transfer in β-thalassemia mice and in hematopoietic cells of β-thalassemia and sickle cells disease patients.

    Directory of Open Access Journals (Sweden)

    Laura Breda

    Full Text Available Preclinical and clinical studies demonstrate the feasibility of treating β-thalassemia and Sickle Cell Disease (SCD by lentiviral-mediated transfer of the human β-globin gene. However, previous studies have not addressed whether the ability of lentiviral vectors to increase hemoglobin synthesis might vary in different patients.We generated lentiviral vectors carrying the human β-globin gene with and without an ankyrin insulator and compared their ability to induce hemoglobin synthesis in vitro and in thalassemic mice. We found that insertion of an ankyrin insulator leads to higher, potentially therapeutic levels of human β-globin through a novel mechanism that links the rate of transcription of the transgenic β-globin mRNA during erythroid differentiation with polysomal binding and efficient translation, as reported here for the first time. We also established a preclinical assay to test the ability of this novel vector to synthesize adult hemoglobin in erythroid precursors and in CD34(+ cells isolated from patients affected by β-thalassemia and SCD. Among the thalassemic patients, we identified a subset of specimens in which hemoglobin production can be achieved using fewer copies of the vector integrated than in others. In SCD specimens the treatment with AnkT9W ameliorates erythropoiesis by increasing adult hemoglobin (Hb A and concurrently reducing the sickling tetramer (Hb S.Our results suggest two major findings. First, we discovered that for the purpose of expressing the β-globin gene the ankyrin element is particularly suitable. Second, our analysis of a large group of specimens from β-thalassemic and SCD patients indicates that clinical trials could benefit from a simple test to predict the relationship between the number of vector copies integrated and the total amount of hemoglobin produced in the erythroid cells of prospective patients. This approach would provide vital information to select the best candidates for these

  5. The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation

    NARCIS (Netherlands)

    Gajic, Ognjen; Malinchoc, Michael; Comfere, Thomas B.; Harris, Marcelline R.; Achouiti, Ahmed; Yilmaz, Murat; Schultz, Marcus J.; Hubmayr, Rolf D.; Afessa, Bekele; Farmer, J. Christopher

    2008-01-01

    OBJECTIVE: Unplanned readmission of hospitalized patients to an intensive care unit (ICU) is associated with a worse outcome, but our ability to identify who is likely to deteriorate after ICU dismissal is limited. The objective of this study is to develop and validate a numerical index, named the

  6. The brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer: a FDG-PET study

    International Nuclear Information System (INIS)

    Zuo, C.T.; Guan, Y.H.; Xu, W.D.; Zhao, J.; Sun, G.X.; Lin, X.T.

    2002-01-01

    Objectives: To study FDG-PET for imaging the brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer. Methods: One male patient with left brachial plexus root avulsion underwent a two-stage procedure (first phase: C7 root → ulnar nerve; second phase: ulnar nerve → recipient nerve) 4 years ago; Another with right brachial plexus root avulsion also underwent a two-stage procedure 3 years ago. First two patients underwent basic FDG-PET imaging, the next day FDG-PET scans were performed after initiative or passive limb movement. Using ROI and MPI tools to evaluate the images. The ratios of sensorimotor frontal cingulated Thalami to white matter were used as the semiquantitive index. Results: Whether brain plasticity had occurred was determined by whether the affected limb can perform initiative movement. The increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with left brachial plexus root avulsion were 40.1%, 37.9%, 48.3%, 31.9% after initiative movement, the right corresponding brain regions were 39.4%, 34.3%, 48.5%,35.4% respectively. However, the increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with right brachial plexus root avulsion were increased by 12.6%, 9.6%, 10.7%, 5.3% after passive movement, the right corresponding brain regions were respectively 17.9%, 12.9%, 15.4%, 10.1%. It was founded that the metabolism of bilateral sensorimotor frontal cingulated Thalami increased after initiative movement, while the metabolism of right sensorimotor frontal cingulated Thalami increased more obviously than that of the left brain regions when using MPI tool to substract the images before and after the affected limb movement. Conclusions: Sensorimotor frontal cingulated Thalami were necessary to the initiative movement. After being activated by movement, the metabolisms of plasticised brain regions increased obviously. However, the

  7. Station Transfers

    Data.gov (United States)

    Department of Homeland Security — ixed rail transit external system transfers for systems within the Continental United States, Alaska, Hawaii, the District of Columbia, and Puerto Rico. The modes of...

  8. Technology transfer

    International Nuclear Information System (INIS)

    1998-01-01

    On the base of technological opportunities and of the environmental target of the various sectors of energy system this paper intend to conjugate the opportunity/objective with economic and social development through technology transfer and information dissemination [it

  9. Three-way ROC validation of rs-fMRI visual information propagation transfer functions used to differentiate between RRMS and CIS optic neuritis patients.

    Science.gov (United States)

    Farahani, Ehsan Shahrabi; Choudhury, Samiul H; Cortese, Filomeno; Costello, Fiona; Goodyear, Bradley; Smith, Michael R

    2017-07-01

    Resting-state fMRI (rs-fMRI) measures the temporal synchrony between different brain regions while the subject is at rest. We present an investigation using visual information propagation transfer functions as potential optic neuritis (ON) markers for the pathways between the lateral geniculate nuclei, the primary visual cortex, the lateral occipital cortex and the superior parietal cortex. We investigate marker reliability in differentiating between healthy controls and ON patients with clinically isolated syndrome (CIS), and relapsing-remitting multiple sclerosis (RRMS) using a three-way receiver operating characteristics analysis. We identify useful and reliable three-way ON related metrics in the rs-fMRI low-frequency band 0.0 Hz to 0.1 Hz, with potential markers associated with the higher frequency harmonics of these signals in the 0.1 Hz to 0.2 Hz and 0.2 Hz to 0.3 Hz bands.

  10. Cost minimization analysis at the Hospital Mexico in the Caja Costarricense de Seguro Social for the accommodation of patients with radiotherapy with linear accelerator: shelter vs transfers

    International Nuclear Information System (INIS)

    Cespedes Quiros, Yehudi; Pereira Barrantes, Edgar

    2010-01-01

    Patients with oncological pathology have attended daily in sessions for several weeks in the linear accelerator radiation therapy. Persons subject to this intervention have moved to the Hospital Mexico of the social security of Costa Rica, place that centralizes this treatment. The Caja Costarricense de Seguro Social (CCSS) has considered two options depending on the place of origin of users: bear the costs of commuting from the area of habitual residence, or place them temporarily in a shelter provided by the institution; the CCSS has chosen the first alternative. This research has consisted of a cost-minimization analysis between these two alternatives. The study population are patients with oncological pathology attending sessions of radiotherapy with linear accelerator at the Hospital Mexico in the first half of 2009 using ambulances of Cruz Roja Costarricense. The size of the study population is 107 persons, the total number of transferred recorded in the Fondo Rotatorio de Operaciones of Hospital Mexico is 998. Patients came from five regions and twenty areas of health according to the geographical division of the CCSS. The variables included have been: cost per day by way of transfer, which involves the distance to the radiotherapy center of Hospital Mexico and the cost of the rate at Cruz Roja ambulance per Km (326.86 colons, according to the agreement CCSS-Cruz Roja in June 2009) estimated daily cost of lodging in a shelter, and the reason daily cost of relocation / daily cost of shelter. The cost of shelter includes food and were used data from the company International Medical Suppliers S. A. as a basis for estimating the daily cost, the price fixed by the company was 65 dollars a day, and the conversion into colons exchange rate as established by the Banco Central de Costa Rica; dated April 30, 2010, the amount has been 33.542.60 colons. The reason for each area of health was given by the ratio of the average daily cost in colons by way of ambulance of

  11. A Gene-Based Prognostic for Hepatocellular Carcinoma Patient Response to Adjuvant Transcatheter Arterial Chemoembolization | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The gold standard of care for hepatocellular carcinoma patients with intermediate- to locally advanced tumors is transcatheter arterial chemoembolization (TACE), a procedure whereby the tumor is targeted both with local chemotherapy and restriction of local blood supply. NCI scientists have identified a 14-gene signature predictive of response to TACE, and NCI seeks licensees or co-development partners to develop the technology toward commercialization.

  12. [Case Reports] Successful pregnancy foilowing gamete intrafallopian transfer in a patient with a transverse vaginal septum: case report

    OpenAIRE

    Ami, Kazumi; Tsuji, Isao; Watanabe, Yo; Fujinami, Nahoko; Miyazaki, Ayako; Hoshiai, Hiroshi

    2010-01-01

    [Abstract] Transverse vaginal septa (TVSs) are rare congenital, obstructive vaginal anomalies resulting from a defect of vertical fusion during embryogenesis of the vagina and are generally diagnosed at the time of pregnancy in association with obstetric complications. TVSs also contribute to infertility. Surgical treatment, such as resection or fenestration of the TVS, is generally indicated. However, the optimal treatment of infertile patients with TVS has not been established, and few case...

  13. SU-F-BRD-14: Dose Weighted Linear Energy Transfer Analysis of Critical Structures in Proton Therapy of Pediatric Brain Tumor Patients

    Energy Technology Data Exchange (ETDEWEB)

    Pirlepesov, F.; Shin, J.; Moskvin, V. P.; Gray, J.; Hua, C.; Gajjar, A.; Krasin, M. J.; Merchant, T. E.; Farr, J. B. [St. Jude Children’s Research Hospital, Memphis, TN (United States); Li, Z. [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2015-06-15

    Purpose: Dose weighted Linear Energy Transfer (LETd) analysis of critical structures may be useful in understanding the side effects of the proton therapy. The objective is to analyze the differences between LETd and dose distributions in brain tumor patients receiving double scattering proton therapy, to quantify LETd variation in critical organs, and to identify beam arrangements contributing to high LETd in critical organs. Methods: Monte Carlo simulations of 9 pediatric brain tumor patients were performed. The treatment plans were reconstructed with the TOPAS Monte Carlo code to calculate LETd and dose. The beam data were reconstructed proximal to the aperture of the double scattering nozzle. The dose and LETd to target and critical organs including brain stem, optic chiasm, lens, optic nerve, pituitary gland, and hypothalamus were computed for each beam. Results: Greater variability in LETd compared to dose was observed in the brainstem for patients with a variety of tumor types including 5 patients with tumors located in the posterior fossa. Approximately 20%–44% brainstem volume received LETd of 5kev/µm or greater from beams within gantry angles 180°±30° for 5 patients treated with a 3 beam arrangement. Critical organs received higher LETd when located in the vicinity of the beam distal edge. Conclusion: This study presents a novel strategy in the evaluation of the proton treatment impact on critical organs. While the dose to critical organs is confined below the required limits, the LETd may have significant variation. Critical organs in the vicinity of beam distal edge receive higher LETd and depended on beam arrangement, e.g. in posterior fossa tumor treatment, brainstem receive higher LETd from posterior-anterior beams. This study shows importance of the LETd analysis of the radiation impact on the critical organs in proton therapy and may be used to explain clinical imaging observations after therapy.

  14. ATTACHMENT AND TRANSFER

    OpenAIRE

    Pasare, Daniela

    2011-01-01

    Bowlby's concept of attachment and Freud's concept of transference are two of the most influential theories of how we construct mental representations of human relationships. The attachment’s theory offers one more strategy for the therapeutic approach. Factors that lead to a secure attachment between mother and child may also be applied to the relationship between patient and psychotherapist. Psychotherapy may help a patient create himself new attachment and relationship patterns. Creating a...

  15. Plasma phospholipid transfer protein activity is related to insulin resistance : impaired acute lowering by insulin in obese Type II diabetic patients

    NARCIS (Netherlands)

    Riemens, SC; van Tol, A; Sluiter, WJ; Dullaart, RPF

    Cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) have important functions in high density lipoprotein (HDL) metabolism. We determined the association of plasma CETP and PLTP activities (measured with exogenous' substrate assays) with insulin resistance, plasma

  16. Technology Transfer

    Science.gov (United States)

    Smith, Nanette R.

    1995-01-01

    The objective of this summer's work was to attempt to enhance Technology Application Group (TAG) ability to measure the outcomes of its efforts to transfer NASA technology. By reviewing existing literature, by explaining the economic principles involved in evaluating the economic impact of technology transfer, and by investigating the LaRC processes our William & Mary team has been able to lead this important discussion. In reviewing the existing literature, we identified many of the metrics that are currently being used in the area of technology transfer. Learning about the LaRC technology transfer processes and the metrics currently used to track the transfer process enabled us to compare other R&D facilities to LaRC. We discuss and diagram impacts of technology transfer in the short run and the long run. Significantly, it serves as the basis for analysis and provides guidance in thinking about what the measurement objectives ought to be. By focusing on the SBIR Program, valuable information regarding the strengths and weaknesses of this LaRC program are to be gained. A survey was developed to ask probing questions regarding SBIR contractors' experience with the program. Specifically we are interested in finding out whether the SBIR Program is accomplishing its mission, if the SBIR companies are providing the needed innovations specified by NASA and to what extent those innovations have led to commercial success. We also developed a survey to ask COTR's, who are NASA employees acting as technical advisors to the SBIR contractors, the same type of questions, evaluating the successes and problems with the SBIR Program as they see it. This survey was developed to be implemented interactively on computer. It is our hope that the statistical and econometric studies that can be done on the data collected from all of these sources will provide insight regarding the direction to take in developing systematic evaluations of programs like the SBIR Program so that they can

  17. Technology transfer

    International Nuclear Information System (INIS)

    Boury, C.

    1986-01-01

    This paper emphasizes in the specific areas of design, engineering and component production. This paper presents what Framatome has to offer in these areas and its export oriented philosophy. Then, a typical example of this technology transfer philosophy is the collaboration with the South Korean firm, Korea Heavy Industries Corporation (KHIC) for the supply of KNU 9 and KNU 10 power stations

  18. Primary to comprehensive stroke center transfers: Appropriateness, not futility.

    Science.gov (United States)

    Goyal, Mayank; Menon, Bijoy K; Wilson, Alexis T; Almekhlafi, Mohammed A; McTaggart, Ryan; Jayaraman, Mahesh; Demchuk, Andrew M; Hill, Michael D

    2018-01-01

    Background and purpose Ischemic stroke patients must be transferred to comprehensive stroke centers for endovascular treatment, but this transfer can be interpreted post hoc as "futile" if patients do not ultimately undergo the procedure or have a poor outcome. We posit that transfer decisions must instead be evaluated in terms of appropriateness at the time of decision-making. Methods We propose a classification schema for Appropriateness of Transfer for Endovascular Thrombectomy based on patient, logistic, and center characteristics. Results The classification outline characteristics of patients that are 1. Appropriate for transfer for endovascular treatment; 2. Inappropriate for transfer; and 3. Appropriate for transfer for higher level of care. Conclusions Appropriate transfer decisions for endovascular treatment are significant for patient outcomes. A more nuanced understanding of transfer decision-making and a classification for such transfers can help minimize inappropriate transfers in acute stroke.

  19. Technology transfer

    International Nuclear Information System (INIS)

    Anon.

    1977-01-01

    Illustrated by the example of the FRG's nuclear energy exports, it is shown that the nuclear technology transfer leads to new dimensions of intergovernmental relations, which hold within themselves on account of multiple state-to-state, scientific, industrial and - last but not least - personal contacts the chance of far-reaching friendships between countries and people. If the chance is taken, this can also be seen as an important contribution towards maintaining the peace. (orig.) [de

  20. Transfer Zymography.

    Science.gov (United States)

    Pan, Daniel; Wilson, Karl A; Tan-Wilson, Anna

    2017-01-01

    The technique described here, transfer zymography, was developed to overcome two limitations of conventional zymography. When proteolytic enzymes are resolved by nonreducing SDS-PAGE into a polyacrylamide gel with copolymerized protein substrate, the presence of the protein substrate can result in anomalous, often slower, migration of the protease and an estimated mass higher than its actual mass. A further drawback is that the presence of a high background of substrate protein interferes with proteomic analysis of the protease band by excision, tryptic digestion, and LC-MS/MS analysis. In transfer zymography, the proteolytic enzymes are resolved by conventional nonreducing SDS-PAGE, without protein substrate in the gel. The proteins in the resolving gel are then electrophoretically transferred to a receiving gel that contains the protein substrate, by a process similar to western blotting. The receiving gel is then processed in a manner similar to conventional zymography. SDS is removed by Triton X-100 and incubated in conditions suitable for the proteolytic activity. After protein staining, followed by destaining, bands representing regions with active protease are visualized as clear bands in a darkly stained background. For proteomic analysis, electrophoresis is carried out simultaneously on a second resolving gel, and the bands corresponding to the clear regions in the receiving gel after zymogram development are excised for proteomic analysis.

  1. Postcontrast T1-weighted brain magnetic resonance imaging in pediatric patients: comparison between postcontrast fat-suppression imaging and conventional T1-weighted or magnetization transfer imaging

    International Nuclear Information System (INIS)

    Lee, Choong Wook; Goo, Hyun Woo

    2004-01-01

    We wished to assess the merits and weaknesses of postcontrast fat-suppression (FS) brain MR imaging in children for the evaluation of various enhancing lesions as compared with postcontrast conventional T1-weighted or magnetization transfer (MT) imaging. We reviewed the records of those patients with enhancing lesions on brain MR imaging who had undergone both FS imaging and one of the conventional T1-weighted or MT imaging as a post-contrast T1-weighted brain MR imaging. Thirty-one patients (21 male, 10 female; mean age, 8.7 years) with 38 enhancing lesions (18 intra-axial, 16 extra-axial and 4 orbital locations) were included in this study. There were 27 pairs of FS and conventional imagings, and 13 pairs of FS and MT imagings available for evaluation. Two radiologists visually assessed by consensus the lesions' conspicuity, and they also looked for the presence of flow or susceptibility artifacts in a total of 40 pairs of MR imagings. For 19 measurable lesions (14 pairs of FS and conventional T1-weighted imagings, 5 pairs of FS and MT imagings), the contrast ratios between the lesion and the normal brain ([SIlesion-SIwater]/[SInormal brain-SIwater]) were calculated and compared. Compared with conventional imaging, the lesion conspicuity on FS imaging was better in 10 cases (7 extra-axial lesions, 2 orbital lesions and 1 fat-containing intra-axial lesion), equal in 16 cases, and worse in one case. Compared with MT imaging, the lesion conspicuity on FS imaging was better in 3 cases (2 extra-axial lesions and 1 intra-axial lesion), equal in 8 cases, and worse in 2 cases. Image quality of FS imaging was compromised by flow or susceptibility artifacts for 7 patients. The contrast ratios for FS imaging were not significantly different from those for conventional imaging (2.2±0.7 vs. 2.2±0.6, respectively, p=0.914) and they were significantly lower than those for MT imaging (2.4±0.8 vs. 4.5±1.5, respectively, p=0.018). Postcontrast FS brain MR imaging appears to be

  2. Facilitating Transfers

    DEFF Research Database (Denmark)

    Kjær, Poul F.

    to specific logics of temporalisation and spatial expansion of a diverse set of social processes in relation to, for example, the economy, politics, science and the mass media. On this background, the paper will more concretely develop a conceptual framework for classifying different contextual orders...... that the essential functional and normative purpose of regulatory governance is to facilitate, stabilise and justify the transfer of condensed social components (such as economic capital and products, political decisions, legal judgements, religious beliefs and scientific knowledge) from one social contexts...

  3. Radionuclide transfer

    International Nuclear Information System (INIS)

    Gerber, G.B.

    1993-01-01

    The research project described here had the aim to obtain further information on the transfer of nuclides during pregnancy and lactation. The tests were carried out in mini-pigs and rats receiving unchanging doses of radionuclides with the food. The following findings were revealed for the elements examined: Fe, Se, Cs and Zn were characterized by very high transfer levels in the mother, infant and foetus. A substantial uptake by the mother alone was observed for Co, Ag and Mn. The uptake by the foetus and infant here was 1 to 10 times lower. A preferential concentration in certain tissues was seen for Sr and Tc; the thyroid levels of Tc were about equally high in mothers and infants, while Sr showed less accumulation in the maternal bone. The lanthanide group of substances (Ce, Eu and Gd as well as Y and Ru) were only taken up to a very limited extent. The uptake of the examined radionuclides (Fe, Co, Ag, Ce) with the food ingested was found here to be ten times greater in rats as compared to mini-pigs. This showed that great caution must be observed, if the behaviour of radionuclides in man is extrapolated from relevant data obtained in rodents. (orig./MG) [de

  4. Facilitating Transfers

    DEFF Research Database (Denmark)

    Kjær, Poul F.

    2018-01-01

    Departing from the paradox that globalisation has implied an increase, rather than a decrease, in contextual diversity, this paper re-assesses the function, normative purpose and location of Regulatory Governance Frameworks in world society. Drawing on insights from sociology of law and world...... society studies, the argument advanced is that Regulatory Governance Frameworks are oriented towards facilitating transfers of condensed social components, such as economic capital and products, legal acts, political decisions and scientific knowledge, from one legally-constituted normative order, i.......e. contextual setting, to another. Against this background, it is suggested that Regulatory Governance Frameworks can be understood as schemes which act as ‘rites of passage’ aimed at providing legal stabilisation to social processes characterised by liminality, i.e ambiguity, hybridity and in-betweenness....

  5. 42 CFR 35.21 - Authorization of transfer.

    Science.gov (United States)

    2010-10-01

    ... EXAMINATIONS HOSPITAL AND STATION MANAGEMENT Transfer of Patients § 35.21 Authorization of transfer. Except as... of a station or hospital of the Service may provide, without any cost to the patient, for the transfer of the patient either from such station or hospital to another station or hospital of the Service...

  6. Heat transfer: Pittsburgh 1987

    International Nuclear Information System (INIS)

    Lyczkowski, R.W.

    1987-01-01

    This book contains papers divided among the following sections: Process Heat Transfer; Thermal Hydraulics and Phase Change Phenomena; Analysis of Multicomponent Multiphase Flow and Heat Transfer; Heat Transfer in Advanced Reactors; General Heat Transfer in Solar Energy; Numerical Simulation of Multiphase Flow and Heat Transfer; High Temperature Heat Transfer; Heat Transfer Aspects of Severe Reactor Accidents; Hazardous Waste On-Site Disposal; and General Papers

  7. [Transference and countertransference in Gestalt therapy].

    Science.gov (United States)

    Schnake Silva, A

    1981-01-01

    The aim is to demonstrate the presence of transference within Gestalt Psychotherapy, opinion not shared by many gestaltists. For this purpose she includes Freud's findings and comments on transference. She also takes into consideration Jung's and Melanie Klein's concepts on transference. The author concludes that transference is in Psychoanalysis a decisive concept in diagnosing and defining a prognosis. She refers to the fact that in Gestalt Psychotherapy the patient projects on the therapist disturbed aspects of his personallity as well as healthy ones, which determines the characteristics of the relationship. In Gestalt Therapy transference is made easy by the self-responsibility the patient has to assume in the process. Within this frame-work some of the techniques which facilitate the use of transference are mentioned: gestual observation, conscience awareness, an alliance with the healthful aspects of the patient, work in the "here-and-now", clarifying projections, switch from environmental support to inner support.

  8. Purification of nonspecific lipid transfer protein (sterol carrier protein 2) from human liver and its deficiency in livers from patients with cerebro-hepato-renal (Zellweger) syndrome

    NARCIS (Netherlands)

    Amerongen, A. van; Helms, J.B.; Krift, T.P. van der; Schutgens, R.B.H.; Wirtz, K.W.A.

    1987-01-01

    The nonspecific lipid transfer protein (i.e., sterol carrier protein 2) from human liver was purified to homogeneity using ammonium sulfate precipitation, CM-cellulose chromatography, molecular sieve chromatography and fast protein liquid chromatography. Its amino acid composition was determined and

  9. Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins

    DEFF Research Database (Denmark)

    Pastorello, Elide A; Farioli, Laura; Conti, Amedeo

    2007-01-01

    for sodium dodecyl sulfate-polyacrylamide gel electrophoresis/immunoblotting of the three Osborne's protein fractions (albumin/globulin, gliadins and glutenins) of raw and cooked wheat. Thermal sensitivity of wheat lipid transfer protein (LTP) was investigated by spectroscopic approaches. IgE cross...

  10. Bimodal ex vivo expansion of T cells from patients with head and neck squamous cell carcinoma: a prerequisite for adoptive cell transfer

    DEFF Research Database (Denmark)

    Junker, Niels; Andersen, Mads Hald; Wenandy, Lynn

    2011-01-01

    Abstract Background aims. Adoptive transfer of tumor-infiltrating lymphocytes (TIL) has proven effective in metastatic melanoma and should therefore be explored in other types of cancer. The aim of this study was to examine the feasibility of potentially expanding clinically relevant quantities o...

  11. The Optimizing Patient Transfers, Impacting Medical Quality, andImproving Symptoms:Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project.

    Science.gov (United States)

    Unroe, Kathleen T; Nazir, Arif; Holtz, Laura R; Maurer, Helen; Miller, Ellen; Hickman, Susan E; La Mantia, Michael A; Bennett, Merih; Arling, Greg; Sachs, Greg A

    2015-01-01

    The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  12. Transfer and Social Practice.

    Science.gov (United States)

    Billett, Stephen

    1998-01-01

    Transfer involves disembodying knowledge and transferring it for use in different contexts. Vocational knowledge arises in communities of practice, and difficulties arise in transferring it from one distinct community, such as a workplace, to another, such as a classroom. (SK)

  13. International technology transfer

    International Nuclear Information System (INIS)

    Kwon, Won Gi

    1991-11-01

    This book introduces technology progress and economic growth, theoretical consideration of technology transfer, policy and mechanism on technology transfer of a developed country and a developing country, reality of international technology transfer technology transfer and industrial structure in Asia and the pacific region, technology transfer in Russia, China and Eastern Europe, cooperation of science and technology for development of Northeast Asia and strategy of technology transfer of Korea.

  14. Technology transfer by multinationals

    OpenAIRE

    Kostyantyn Zuzik

    2003-01-01

    The paper analyses the issue of technology transfer by multinational corporations. The following questions are explored: (a) world market of technologies, the role of MNCs (b) Choice of the technology transfer mode, Dunning's OLI-theory as a factor of the choice of the mode of transfer (c) measurement and profitability of technology transfer (d) transfer of technology through partnerships, JVs, alliances and through M&As (e) aspects of technology transfer by services multinationals. Paper uti...

  15. Information transfer to out-of-hours co-operatives: a survey of general practitioners' views in relation to palliative patients.

    LENUS (Irish Health Repository)

    Kiely, Fiona

    2013-12-01

    In Ireland, weekend and night medical cover for community based patients is largely provided by general practice co-operatives. Doctors working in this service do not have direct access to patients\\' medical records which challenges continuity of care.

  16. Analysis of molecular intra-patient variation and delineation of a prognostic 12-gene signature in non-muscle invasive bladder cancer; technology transfer from microarrays to PCR

    DEFF Research Database (Denmark)

    Andersen, Lars Dyrskjøt; Reinert, Thomas; Novoradovsky, A

    2012-01-01

    . Methods: We measured the intra-patient variation of an 88-gene progression signature using 39 metachronous tumours from 17 patients. For delineation of the optimal quantitative reverse transcriptase PCR panel of markers, we used 115 tumour samples from patients in Denmark, Sweden, UK and Spain. Results...

  17. Serial contrast-enhanced magnetic resonance and magnetization transfer in the study of patients with multiple sclerosis; Resonancia magnetica con contraste y transferencia de magnetizacion en el estudio seriado de pacientes con esclerosis multiple

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A; Alonso, J; Cucurella, G; Nos, C; Tintore, M; Pedraza, S; Rio, J; Montalban, X [Hospital General i Universitari Vall d` Hebron. Barcelona (Spain)

    1998-12-31

    To demonstrate the changes in the magnetization transfer ratio (MTR) of different demyelinating plaques, correlating them with the baseline values in T1-weighted contrast-enhanced magnetic resonance (MR) sequences in order to relate them more closely to the underlying disease. The study was based on 33 demyelinating plaques obtained from six patients clinically diagnosed as having remitting-recurring multiple sclerosis (MS). All the patients underwent two MR studies at a 3 to 5-month interval, including contrast-enhanced T1 and T2- weighted sequences and magnetization transfer images. The latter were used to calculate the MTR for each of the demyelinating plaques included in the study. The statistical analysis of the results obtained revealed statistically significant between initial MTR values and those of subsequent T1-weighted sequences. The MTR demonstrate significant differences between plaques according to contrast-enhanced T1-weigh tes sequences, probably indicating variable degrees of edema, demyelination and tissue destruction. These differences should be taken into account to enable the use of T1-weighted sequences to quantify the lesion load in MS patients. (Author) 35 refs.

  18. Transfer of omega-3 fatty acids across the blood-brain barrier after dietary supplementation with a docosahexaenoic acid-rich omega-3 fatty acid preparation in patients with Alzheimer's disease: the OmegAD study.

    Science.gov (United States)

    Freund Levi, Y; Vedin, I; Cederholm, T; Basun, H; Faxén Irving, G; Eriksdotter, M; Hjorth, E; Schultzberg, M; Vessby, B; Wahlund, L-O; Salem, N; Palmblad, J

    2014-04-01

    Little is known about the transfer of essential fatty acids (FAs) across the human blood-brain barrier (BBB) in adulthood. In this study, we investigated whether oral supplementation with omega-3 (n-3) FAs would change the FA profile of the cerebrospinal fluid (CSF). A total of 33 patients (18 receiving the n-3 FA supplement and 15 receiving placebo) were included in the study. These patients were participants in the double-blind, placebo-controlled randomized OmegAD study in which 204 patients with mild Alzheimer's disease (AD) received 2.3 g n-3 FA [high in docosahexaenoic acid (DHA)] or placebo daily for 6 months. CSF FA levels were related to changes in plasma FA and to CSF biomarkers of AD and inflammation. At 6 months, the n-3 FA supplement group displayed significant increases in CSF (and plasma) eicosapentaenoic acid (EPA), DHA and total n-3 FA levels (P acid were strongly correlated, in contrast to those of DHA. Changes in DHA levels in CSF were inversely correlated with CSF levels of total and phosphorylated tau, and directly correlated with soluble interleukin-1 receptor type II. Thus, the more DHA increased in CSF, the greater the change in CSF AD/inflammatory biomarkers. Oral supplementation with n-3 FAs conferred changes in the n-3 FA profile in CSF, suggesting transfer of these FAs across the BBB in adults. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  19. A polymorphic variant in the human electron transfer flavoprotein alpha-chain (alpha-T171) displays decreased thermal stability and is overrepresented in very-long-chain acyl-CoA dehydrogenase-deficient patients with mild childhood presentation

    DEFF Research Database (Denmark)

    Bross, P; Pedersen, P; Nyholm, M

    1999-01-01

    The consequences of two amino acid polymorphisms of human electron transfer flavoprotein (alpha-T/I171 in the alpha-subunit and beta-M/T154 in the beta-subunit) on the thermal stability of the enzyme are described. The alpha-T171 variant displayed a significantly decreased thermal stability, wher....... This is compatible with a negative modulating effect of the less-stable alpha-T171 ETF variant in this group of VLCAD patients that harbor missense mutations in at least one allele and therefore potentially display residual levels of VLCAD enzyme activity. Udgivelsesdato: 1999-Jun...

  20. Single-embryo transfer versus multiple-embryo transfer.

    Science.gov (United States)

    Gerris, Jan

    2009-01-01

    Despite the progress made in assisted reproductive technology, live birth rates remain disappointingly low. Multiple-embryo transfer has been an accepted practice with which to increase the success rate. This has led to a higher incidence of multiple-order births compared with natural conception, which not only increase the risk of mortality and morbidity to both mother and children but are also associated with social and economic consequences. Elective single-embryo transfer (eSET) was developed in an effort to increase singleton pregnancies in assisted reproduction. Studies comparing eSET with multiple-embryo transfer highlight the benefit of this approach and suggest that, with careful patient selection and the transfer of good-quality embryos, the risk of a multiple-order pregnancy can be reduced without significantly decreasing live birth rates. Although the use of eSET has gradually increased in clinical practice, its acceptance has been limited by factors such as availability of funding and awareness of the procedure. An open discussion of eSET is warranted in an effort to enable a broader understanding by physicians and patients of the merits of this approach. Ultimately, eSET may provide a more cost-effective, potentially safer approach to patients undergoing assisted reproduction technology.

  1. Cryogenic heat transfer

    CERN Document Server

    Barron, Randall F

    2016-01-01

    Cryogenic Heat Transfer, Second Edition continues to address specific heat transfer problems that occur in the cryogenic temperature range where there are distinct differences from conventional heat transfer problems. This updated version examines the use of computer-aided design in cryogenic engineering and emphasizes commonly used computer programs to address modern cryogenic heat transfer problems. It introduces additional topics in cryogenic heat transfer that include latent heat expressions; lumped-capacity transient heat transfer; thermal stresses; Laplace transform solutions; oscillating flow heat transfer, and computer-aided heat exchanger design. It also includes new examples and homework problems throughout the book, and provides ample references for further study.

  2. Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute SCI Center.

    Science.gov (United States)

    Richard-Denis, Andréane; Ehrmann Feldman, Debbie; Thompson, Cynthia; Bourassa-Moreau, Étienne; Mac-Thiong, Jean-Marc

    2017-07-01

    Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center. Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P SCI center was the main predictive factor of longer LOS and increased costs. Early admission to the SCI center was associated with shorter LOS and lower costs for patients sustaining tetraplegia. Early referral to an SCI center before surgery could lower the financial burden for the health care system. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the optimal timing for transfer of individuals with cervical traumatic spinal cord injury (SCI) in order to decrease acute care resource utilization; (2) Determine benefits of a complete perioperative management in a specialized SCI center; and (3) Identify factors that may influence resource utilization for acute care following motor-complete tetraplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit

  3. Analysis of Heat Transfer

    International Nuclear Information System (INIS)

    2003-08-01

    This book deals with analysis of heat transfer which includes nonlinear analysis examples, radiation heat transfer, analysis of heat transfer in ANSYS, verification of analysis result, analysis of heat transfer of transition with automatic time stepping and open control, analysis of heat transfer using arrangement of ANSYS, resistance of thermal contact, coupled field analysis such as of thermal-structural interaction, cases of coupled field analysis, and phase change.

  4. [The planned home care transfer by a local medical support hospital and the introduction to home intravenous hyper alimentation--the making of a home care patient's instruction plan document].

    Science.gov (United States)

    Shinobu, Akiko; Ohtsu, Yoko

    2004-12-01

    It is important to offer continuous medical service without interrupting everyone's various job functions at the Tama Numbu-Chiiki Hospitals in order to secure the quality and safety of home medical care to patients and their families. From 1998 up to the present, home intravenous hyper alimentation (home IVH) has been introduced by individually exchanging information that was based on items such as clinical case, doctor and caregiver in charge of the day, and introductory information. Five years have passed since we started an introduction of home IVH, and it appears that the medical cooperation of home IVH between the Minami-tama medical region and its neighboring area has been established. Then, we arranged an examination of the past 2 years based on the 57 patients who elected to choose home IVH instruction. Consequently, we created "home IVH introduction plan document" in standardizing a flow from home IVH introduction to post-hospital intervention. Since November of 2003, the plan document has been utilized and carried out to 5 patients by the end of February in 2004. This home IVH introduction plan document was able to clarify the role of medical person in connection with the patient. Therefore, we could not only share the information, but also could transfer medical care smoothly from the hospital to the patient's home.

  5. Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients.

    Science.gov (United States)

    Zhang, Xiangmin; Liu, Folin; Lan, Xiaolin; Huang, Jing; Luo, Keqing; Li, Shaojin

    2015-07-01

    If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6-53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and

  6. Aspectos ergonômicos na transferência de pacientes: um estudo realizado com trabalhadores de uma central de transportes de um hospital universitário Aspectos ergonómicos en la transferencia de enfermos: un estudio hecho com trabajadores de una central de transportes de un hospital universitário The transfer of patients and its ergonomic aspects: a study conducted at a university hospital lifting center

    Directory of Open Access Journals (Sweden)

    Cristiane Gonzales Rossi

    2001-09-01

    Full Text Available Com o objetivo de avaliar aspectos ergonômicos na transferência de pacientes com a utilização de maca e cadeira de rodas, observou-se 249 transferências realizadas por trabalhadores da Seção de Escolta de um Hospital Universitário. Os resultados sugerem que a existência dessa equipe é uma iniciativa que deve ser estimulada mas que esses trabalhadores precisam de treinamento específico sobre movimentação e transporte de pacientes e de terem à disposição materiais auxiliares e equipamentos mecânicos.Com el objetivo de avaliar aspectos ergonómicos de transferencia de enfermos com utilización de maca y silla de ruedas, observarán se 249 transferencias realizadas por trabajadores de la Sección de Escolta (Acompañamiento de un Hospital Universitário. Los resultados sugerem que la existencia desse equipo es una iniciativa que debrá ser estimulada. Pero esos trabajadores necessitan entrenamiento especifico sobre mobilizacion y transporte de enfermos e necessitam tener a disposicion materiales auxiliares y equipamentos mecânicos.The purpose of this study was to evaluate ergonomic aspects involved in using a stretcher and a wheel chair to transfer patients. 249 transfers carried out by the workers of a university hospital lifting sector were observed. The observations showed that the idea of having a team to transfer patients has to be stimulated but the members of the team require specific training in handling and transferring patients. Mechanical equipment and other devices should also be available.

  7. Ergonomics and patient handling.

    Science.gov (United States)

    McCoskey, Kelsey L

    2007-11-01

    This study aimed to describe patient-handling demands in inpatient units during a 24-hour period at a military health care facility. A 1-day total population survey described the diverse nature and impact of patient-handling tasks relative to a variety of nursing care units, patient characteristics, and transfer equipment. Productivity baselines were established based on patient dependency, physical exertion, type of transfer, and time spent performing the transfer. Descriptions of the physiological effect of transfers on staff based on patient, transfer, and staff characteristics were developed. Nursing staff response to surveys demonstrated how patient-handling demands are impacted by the staff's physical exertion and level of patient dependency. The findings of this study describe the types of transfers occurring in these inpatient units and the physical exertion and time requirements for these transfers. This description may guide selection of the most appropriate and cost-effective patient-handling equipment required for specific units and patients.

  8. Expert Performance Transfer: Making Knowledge Transfer Count

    International Nuclear Information System (INIS)

    Turner, C.L.; Braudt, T.E.

    2011-01-01

    'Knowledge Transfer' is a high-priority imperative as the nuclear industry faces the combined effects of an aging workforce and economic pressures to do more with less. Knowledge Transfer is only a part of the solution to these challenges, however. The more compelling and immediate need faced by industry is Accomplishment Transfer, or the transference of the applied knowledge necessary to assure optimal performance transfer from experienced, high-performing staff to inexperienced staff. A great deal of industry knowledge and required performance information has been documented in the form of procedures. Often under-appreciated either as knowledge stores or as drivers of human performance, procedures, coupled with tightly-focused and effective training, are arguably the most effective influences on human and plant performance. (author)

  9. Waste Transfer Stations

    DEFF Research Database (Denmark)

    Christensen, Thomas Højlund

    2011-01-01

    tion and transport is usually the most costly part of any waste management system; and when waste is transported over a considerable distance or for a long time, transferring the waste from the collection vehicles to more efficient transportation may be economically beneficial. This involves...... a transfer station where the transfer takes place. These stations may also be accessible by private people, offering flexibility to the waste system, including facilities for bulky waste, household hazardous waste and recyclables. Waste transfer may also take place on the collection route from small...... describes the main features of waste transfer stations, including some considerations about the economical aspects on when transfer is advisable....

  10. A workshop model for educating medical practitioners about optimal treatment of difficult-to-manage patients: utilization of transference-countertransference.

    Science.gov (United States)

    Klyman, Cassandra M; Browne, Malachy; Austad, Carol; Spindler, Evangeline J; Spindler, Alvin Curtis

    2008-01-01

    Some patients are unable to participate in a good, mutually cooperative relationship with their primary care doctors. They may have long-standing psychosocial difficulties exacerbated by chronic, painful, or life-threatening illnesses. Some may have somatic symptoms that they define as evidence only of an identified illness but which are reflections of psychic misery with roots in their thoughts, feelings, and relationships. This article describes a Workshop approach to teaching those patients' physicians how to make diagnostic use of their own "gut reactions" to understand the common dynamics of the doctor- patient relationship; to understand the psychological aspects of various physical symptoms; and manage challenging patients to optimize their quality of life, cost-effectiveness of treatment and minimize physician "burnout."

  11. Effect of air bubble localization after transfer on embryo transfer outcomes.

    Science.gov (United States)

    Tiras, Bulent; Korucuoglu, Umit; Polat, Mehtap; Saltik, Ayse; Zeyneloglu, Hulusi Bulent; Yarali, Hakan

    2012-09-01

    Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes. Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal. The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups. An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform.

    Science.gov (United States)

    Abidi, Samina; Vallis, Michael; Piccinini-Vallis, Helena; Imran, Syed Ali; Abidi, Syed Sibte Raza

    2018-04-18

    Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. The aim of this study was to develop and evaluate a computerized decision support platform called "Diabetes Web-Centric Information and Support Environment" (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines-based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners' readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association's (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients' progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient's self-management program and associated behavior interventions are

  13. Convective heat transfer

    CERN Document Server

    Kakac, Sadik; Pramuanjaroenkij, Anchasa

    2014-01-01

    Intended for readers who have taken a basic heat transfer course and have a basic knowledge of thermodynamics, heat transfer, fluid mechanics, and differential equations, Convective Heat Transfer, Third Edition provides an overview of phenomenological convective heat transfer. This book combines applications of engineering with the basic concepts of convection. It offers a clear and balanced presentation of essential topics using both traditional and numerical methods. The text addresses emerging science and technology matters, and highlights biomedical applications and energy technologies. What’s New in the Third Edition: Includes updated chapters and two new chapters on heat transfer in microchannels and heat transfer with nanofluids Expands problem sets and introduces new correlations and solved examples Provides more coverage of numerical/computer methods The third edition details the new research areas of heat transfer in microchannels and the enhancement of convective heat transfer with nanofluids....

  14. Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial.

    Science.gov (United States)

    Ramallo-Fariña, Yolanda; García-Pérez, Lidia; Castilla-Rodríguez, Iván; Perestelo-Pérez, Lilisbeth; Wägner, Ana María; de Pablos-Velasco, Pedro; Domínguez, Armando Carrillo; Cortés, Mauro Boronat; Vallejo-Torres, Laura; Ramírez, Marcos Estupiñán; Martín, Pablo Pedrianes; García-Puente, Ignacio; Salinero-Fort, Miguel Ángel; Serrano-Aguilar, Pedro Guillermo

    2015-04-09

    Type 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals' decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands. The INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18-65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients. Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients' results. Group 3 is receiving a combination of the interventions for patients and professionals. The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used

  15. Introduction to heat transfer

    CERN Document Server

    SUNDÉN, B

    2012-01-01

    Presenting the basic mechanisms for transfer of heat, Introduction to Heat Transfer gives a deeper and more comprehensive view than existing titles on the subject. Derivation and presentation of analytical and empirical methods are provided for calculation of heat transfer rates and temperature fields as well as pressure drop. The book covers thermal conduction, forced and natural laminar and turbulent convective heat transfer, thermal radiation including participating media, condensation, evaporation and heat exchangers.

  16. Efficiency and safety of transfer of type 2 diabetes patients inadequately controlled on metformin alone to combined therapy with metformin and diabeton MB

    Directory of Open Access Journals (Sweden)

    Alexander Sergeevich Ametov

    2009-12-01

    Full Text Available Aim. To evaluate efficiency and tolerability of diabeton MB/metformin combination in patients failing to achieve optimal glycemic control when onmetformin monotherapy and prove advantages of this combination over combined low-dose therapy with glibenclamide and metformin. Materials and methods. The study included 464 patients with type 2 diabetes mellitus who poorly responded to metformin monotherapy. It was supplementedby diabeton MB. Efficiency and tolerability of combined treatment was evaluated from dynamics of glycemia and frequency of side-effects.40 patients were included in detailed comparative assessment (laboratory and instrumental, CGMS of this monotherapy and fixed low-dose combinationof glibenclamide with metformin. Results. Results of comparison show that diabeton MB/metformin combination ensured most optimal glycemic control with a minimal risk of side effects. Conclusion. Diabeton MB/metformin combination is convenient, efficient and safe.

  17. Efectos adversos asociados al tratamiento con factor de transferencia: Ciudad de La Habana, 2004 Adverse drug effects associated to the treatment of patients with transfer factor: City of Havana , 2004

    Directory of Open Access Journals (Sweden)

    María Aida Cruz Barrios

    2006-04-01

    Full Text Available El factor de transferencia (Hebertrans constituye un inmunoestimulante que se emplea en una amplia gama de enfermedades. Su seguridad ha sido evaluada en los ensayos clínicos pre-registro, pero no así en investigaciones poscomercialización, por tal motivo se realizó un estudio observacional y multicéntrico de vigilancia activa, en pacientes tratados con factor de transferencia en 11 hospitales de la Ciudad de La Habana , para identificar los eventos presentados durante el tratamiento, así como clasificarlos según su causalidad y gravedad. La información fue recogida por el médico inmunólogo de cada hospital y supervisada por el farmacoepidemiólogo hospitalario. Durante el tratamiento se obtuvo información de 387 pacientes y se reportaron 133 eventos en 86 casos (22,2 %. Los más frecuentes fueron fiebre, dolor y eritema en el sitio de la inyección, cefalea y diarrea; el 92,5 % de los eventos observados fueron leves. El 27,8 % se clasificó como definitivamente provocados por el fármaco, estos últimos relacionados con la vía de administración. El factor de transferencia resultó un medicamento seguro en los pacientes observadosTransfer factor called Hebertrans is an immunostimulant used in a wide range of diseases. The safety of this drug has been assessed in several clinical assays prior to registration, but not in aftermarket research studies. Therefore, a multicenter observational study of active surveillance was carried out in patients treated with transfer factor in 11 hospitals located in the City of Havana to detect adverse events in the course of treatment, and then to classify them by cause and severity. Data was collected by the immunologist in each hospital and supervised by the pharmacological epidemiologist. During the treatment, information was gathered from 387 patients where 133 events were reported in 86 cases (22,2%. The most frequent were fever, pain, erythema at the site of injection, headache and diarrhea; 92

  18. Evaluation of the educational technology "Caring for dependent people" by family caregivers in changes and transfers of patients and tube feeding

    Directory of Open Access Journals (Sweden)

    Maria José Lumini Landeiro

    Full Text Available ABSTRACT Objective: to assess the contributions of interactive educational technology "Caring for Dependent People" in the development of knowledge to family caregivers of dependent people in a household context and their satisfaction in its use. Method: quasi-experimental study, not randomized, of the before and after type, with a convenience sample of 65 family caregivers, from two Medicine services of a hospital in Porto, Portugal. The Control Group consisted of 33 family caregivers and the Experimental Group of 32, identified by consecutive sampling. The experimental group had access to educational technology at home. Data were collected by socio-demographic, satisfaction and evaluation of knowledge questionnaire, about how to feed by nasogastric tube, positioning and transferring the dependent person. The assessment in both groups had two moments: initial, during hospitalization and one month after discharge. Results: the experimental group had a larger increase in knowledge related to the use of the educational technology. In the control group the knowledge did not differ in the two evaluation time points. Conclusion: these results confirm the improvement of interactive educational technologies and in the training of family caregivers to care for dependents. This technology successfully met the technical quality and learning needs of caregivers, and was considered easy and stimulating.

  19. Learning from the patient: the East, synchronicity and transference in the history of an unknown case of C.G. Jung.

    Science.gov (United States)

    de Moura, Vicente

    2014-06-01

    This article presents the history of one until now unknown case of C.G. Jung: Maggy Reichstein. Born in Indonesia in 1894 in a very aristocratic family, she brought her sister to Zurich to be treated by Jung in 1919, and later she herself was in analysis with him. Jung used her case as example in his lecture in 1937 on the realities of practical psychotherapy, relating it to the process of transference and countertransference. Jung deepened his studies in Eastern psychology after a series of dreams she had, which culminated in the Yoga Kundalini Seminars. She was also the case presented in his article of 1951 on the concept of synchronicity. Jung wrote that her case, concerning synchronicity, remained unique in his experience. Jung also published some of her mandalas. He considered her able to understand his ideas in depth. Reichstein was for Jung an important case, which challenged and triggered his interests in different subjects. © 2014, The Society of Analytical Psychology.

  20. Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: a systematic overview of reviews.

    NARCIS (Netherlands)

    Franx, G.C.; Kroon, H.; Grimshaw, J.; Drake, R.; Grol, R.P.T.M.; Wensing, M.J.P.

    2008-01-01

    OBJECTIVE: To provide a comprehensive overview of the research on organizational changes aimed at improving health care for patients with severe mental illness and to learn lessons for mental health practice from the results. METHOD: We searched for systematic literature reviews published in English

  1. Intramolecular Energy Transfer, Charge Transfer & Hydrogen Bond

    Indian Academy of Sciences (India)

    Ultrafast Dynamics of Chemical Reactions in Condensed Phase: Intramolecular Energy Transfer, Charge Transfer & Hydrogen Bond · PowerPoint Presentation · Slide 3 · Slide 4 · Slide 5 · Slide 6 · Slide 7 · Slide 8 · Slide 9 · Slide 10 · Slide 11 · Slide 12 · Slide 13 · Slide 14 · Slide 15 · Slide 16 · Slide 17 · Slide 18 · Slide 19.

  2. Heat transfer system

    Science.gov (United States)

    Not Available

    1980-03-07

    A heat transfer system for a nuclear reactor is described. Heat transfer is accomplished within a sealed vapor chamber which is substantially evacuated prior to use. A heat transfer medium, which is liquid at the design operating temperatures, transfers heat from tubes interposed in the reactor primary loop to spaced tubes connected to a steam line for power generation purposes. Heat transfer is accomplished by a two-phase liquid-vapor-liquid process as used in heat pipes. Condensible gases are removed from the vapor chamber through a vertical extension in open communication with the chamber interior.

  3. Fuel transfer machine

    International Nuclear Information System (INIS)

    Bernstein, I.

    1978-01-01

    A nuclear fuel transfer machine for transferring fuel assemblies through the fuel transfer tube of a nuclear power generating plant containment structure is described. A conventional reversible drive cable is attached to the fuel transfer carriage to drive it horizontally through the tube. A shuttle carrying a sheave at each end is arranged in parallel with the carriage to also travel into the tube. The cable cooperating with the sheaves permit driving a relatively short fuel transfer carriage a large distance without manually installing sheaves or drive apparatus in the tunnel. 8 claims, 3 figures

  4. Electron transfer reactions

    CERN Document Server

    Cannon, R D

    2013-01-01

    Electron Transfer Reactions deals with the mechanisms of electron transfer reactions between metal ions in solution, as well as the electron exchange between atoms or molecules in either the gaseous or solid state. The book is divided into three parts. Part 1 covers the electron transfer between atoms and molecules in the gas state. Part 2 tackles the reaction paths of oxidation states and binuclear intermediates, as well as the mechanisms of electron transfer. Part 3 discusses the theories and models of the electron transfer process; theories and experiments involving bridged electron transfe

  5. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

    Science.gov (United States)

    Aziz, Aznida Firzah Abdul; Aziz, Noor Azah Abd; Nordin, Nor Azlin Mohd; Ali, Mohd Fairuz; Sulong, Saperi; Aljunid, Syed Mohamed

    2013-01-01

    Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100) to 90.5 (range: 27−100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0−22) to 3.0 (range: 0−19) though the change was not significant (Z= −0.744, P = 0.457). Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level. PMID:24347948

  6. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Aznida Firzah Abdul Aziz

    2013-01-01

    Full Text Available Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s control, depression according to Patient Health Questionnaire (PHQ9, and level of independence using Barthel Index (BI. Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD 10.9] years, mean stroke episodes were 1.30 (SD 0.5. The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0 months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007, while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06. Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100 to 90.5 (range: 27−100 (Z = 2.34, P = 0.01. Median PHQ9 scores decreased from 4.0 (range: 0−22 to 3.0 (range: 0−19 though the change was not significant (Z= −0.744, P = 0.457. Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.

  7. Transfer function combinations

    KAUST Repository

    Zhou, Liang; Schott, Mathias; Hansen, Charles

    2012-01-01

    Direct volume rendering has been an active area of research for over two decades. Transfer function design remains a difficult task since current methods, such as traditional 1D and 2D transfer functions, are not always effective for all data sets. Various 1D or 2D transfer function spaces have been proposed to improve classification exploiting different aspects, such as using the gradient magnitude for boundary location and statistical, occlusion, or size metrics. In this paper, we present a novel transfer function method which can provide more specificity for data classification by combining different transfer function spaces. In this work, a 2D transfer function can be combined with 1D transfer functions which improve the classification. Specifically, we use the traditional 2D scalar/gradient magnitude, 2D statistical, and 2D occlusion spectrum transfer functions and combine these with occlusion and/or size-based transfer functions to provide better specificity. We demonstrate the usefulness of the new method by comparing to the following previous techniques: 2D gradient magnitude, 2D occlusion spectrum, 2D statistical transfer functions and 2D size based transfer functions. © 2012 Elsevier Ltd.

  8. Heat transfer enhancement

    International Nuclear Information System (INIS)

    Hasatani, Masanobu; Itaya, Yoshinori

    1985-01-01

    In order to develop energy-saving techniques and new energy techniques, and also most advanced techniques by making industrial equipment with high performance, heat transfer performance frequently becomes an important problem. In addition, the improvement of conventional heat transfer techniques and the device of new heat transfer techniques are often required. It is most proper that chemical engineers engage in the research and development for enhancing heat transfer. The research and development for enhancing heat transfer are important to heighten heat exchange efficiency or to cool equipment for preventing overheat in high temperature heat transfer system. In this paper, the techniques of enhancing radiative heat transfer and the improvement of radiative heat transfer characteristics are reported. Radiative heat transfer is proportional to fourth power of absolute temperature, and it does not require any heat transfer medium, but efficient heat-radiation converters are necessary. As the techniques of enhancing radiative heat transfer, the increase of emission and absorption areas, the installation of emissive structures and the improvement of radiative characteristics are discussed. (Kako, I.)

  9. Transfer function combinations

    KAUST Repository

    Zhou, Liang

    2012-10-01

    Direct volume rendering has been an active area of research for over two decades. Transfer function design remains a difficult task since current methods, such as traditional 1D and 2D transfer functions, are not always effective for all data sets. Various 1D or 2D transfer function spaces have been proposed to improve classification exploiting different aspects, such as using the gradient magnitude for boundary location and statistical, occlusion, or size metrics. In this paper, we present a novel transfer function method which can provide more specificity for data classification by combining different transfer function spaces. In this work, a 2D transfer function can be combined with 1D transfer functions which improve the classification. Specifically, we use the traditional 2D scalar/gradient magnitude, 2D statistical, and 2D occlusion spectrum transfer functions and combine these with occlusion and/or size-based transfer functions to provide better specificity. We demonstrate the usefulness of the new method by comparing to the following previous techniques: 2D gradient magnitude, 2D occlusion spectrum, 2D statistical transfer functions and 2D size based transfer functions. © 2012 Elsevier Ltd.

  10. Making benefit transfers work

    DEFF Research Database (Denmark)

    Bateman, I.J.; Brouwer, R.; Ferrini, S.

    We develop and test guidance principles for benefits transfers. These argue that when transferring across relatively similar sites, simple mean value transfers are to be preferred but that when sites are relatively dissimilar then value function transfers will yield lower errors. The paper also...... provides guidance on the appropriate specification of transferable value functions arguing that these should be developed from theoretical rather than ad-hoc statistical principles. These principles are tested via a common format valuation study of water quality improvements across five countries. Results...... support our various hypotheses providing a set of principles for future transfer studies. The application also considers new ways of incorporating distance decay, substitution and framing effects within transfers and presents a novel water quality ladder....

  11. Race, Identity and the Transference/Countertransference: A Mixed –Race Patient and a Mixed-Race Therapist- A Single Case Study

    OpenAIRE

    Millar, Tennyson

    2014-01-01

    This thesis is a single case-study of a child and adolescent psychotherapist working with a fourteen year old female adolescent patient of similar mixed ethnic background. The thesis presents the completed two year therapeutic work which included periods of intensive therapy (3-4 times-a-week work) following less intensive work.\\ud The patient’s early life was marked by witnessing parental domestic violence and parents who divorced. She subsequently struggled with maintaining relationships an...

  12. Contribution of Human Immunodeficiency Virus Type 1 Minority Variants to Reduced Drug Susceptibility in Patients on an Integrase Strand Transfer Inhibitor-Based Therapy

    Czech Academy of Sciences Publication Activity Database

    Gibson, R. M.; Weber, Jan; Winner, D.; Miller, M. D.; Quinones-Mateu, M. E.

    2014-01-01

    Roč. 9, č. 8 (2014), e104512/1-e104512/14 E-ISSN 1932-6203 R&D Projects: GA MŠk(CZ) LK11207 Institutional support: RVO:61388963 Keywords : treatment-naive patients * HIV -1 genotyping assay * replicative fitness Subject RIV: EE - Microbiology, Virology Impact factor: 3.234, year: 2014 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0104512

  13. Transferência do músculo tríceps para bíceps em pacientes com lesão crônica do tronco superior do plexo braquial Muscle transfer from triceps to biceps in patients with chronic injury of the upper trunk of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Fabiano Inácio de Souza

    2010-01-01

    Full Text Available OBJETIVO: Avaliar os resultados da transposição do tríceps para a flexão do cotovelo em pacientes portadores de lesão crônica e completa do tronco superior do plexo braquial. MÉTODOS: Estudo retrospectivo, com inclusão apenas de pacientes que apresentassem bíceps grau 0 e tríceps grau 5, submetidos à transferência anterior do músculo tríceps, operados entre 1998 e 2005. Foram pesquisados o lado acometido, o sexo, o tipo de acidente, a força de flexão do cotovelo, as complicações e a satisfação do pacientes, em 11 casos. RESULTADOS: 10 pacientes eram do sexo masculino; a idade variou de 24 a 49 anos, com média de 33,7 anos. O tempo mínimo entre a lesão e o procedimento cirúrgico foi de 21 meses (variando de 21 a 74 meses. O lado esquerdo foi acometido em oito casos, enquanto o direito apenas em três. Obtiveram-se bons resultados em 10 pacientes, que adquiriram força de flexão do cotovelo grau 3 (dois casos e grau 4 (oito casos, enquanto um evoluiu desfavoravelmente, com força grau 2. Dois casos evoluíram com complicações (síndrome compartimental inicial e tensionamento insuficiente. Todos os pacientes definiram-se como satisfeitos com o procedimento. CONCLUSÃO: A transposição anterior do músculo tríceps proporcionou satisfação dos pacientes em todos os casos, exceto um, obtendo-se forças grau 4 em oito casos, grau 3 em dois casos e grau 2 em um caso.OBJETIVE: To evaluate the transposition of the triceps for elbow flexion in patients with chronic and complete injury to the upper trunk of the brachial plexus. METHODS: Retrospective study, including only patients who had biceps grade 0 and triceps grade 5, who underwent anterior transfer of the triceps muscle, operated between 1998 and 2005. The affected side, sex, type of accident, strength of elbow flexion, complications and satisfaction of patients, were studied in 11 cases. RESULTS: 10 patients were male, aged 24 to 49 years, with a mean of 33.7 years. The

  14. The "erotic transference": some technical and countertransferential difficulties.

    Science.gov (United States)

    Book, H E

    1995-01-01

    This paper highlights dynamics that may interfere with the therapist's identifying and addressing the erotic transference: (1) deficient training; (2) theoretical orientations that devalue the transference while espousing a "real" relationship including self-disclosure; (3) countertransference responses to the erotic transference; and (4) clinical errors of focusing on the manifest erotic transference while overlooking significant but latent pre-oedipal, oedipal, aggressive, or selfobject issues. Inattention to these dynamics may render the therapist vulnerable to sexual acting out with his patient.

  15. Radiopharmaceuticals to monitor gene transfer

    International Nuclear Information System (INIS)

    Wiebe, L. I.; Morin, K. W.; Knaus, E. E.

    1997-01-01

    Advances in genetic engineering and molecular biology have opened the door to disease treatment by transferring genes to cells that are responsible for the pathological condition being addressed. These genes can serve to supplement or introduce the function of indigenous genes that are either inadequately expressed or that are congenitally absent in the patient. They can introduce new functions such as drug sensitization to provide a unique therapeutic target. Gene transfer is readily monitored in vitro using a range of histochemical and biochemical tests that are ''built in'' to the therapeutic gene cassette. In vivo, in situ monitoring of the gene transfer and gene expression processes can be achieved with these tests only if biopsy is possible. Scintigraphic imaging can offer unique information on both the extent and location of gene expression, provided that an appropriate reporter gene is included in the therapeutic cassette. This overview includes a brief orientation to gene transfer therapy and is followed by a review of current approaches to gene therapy imaging. The concluding section deals with imaging based on radiolabelled nucleoside substrates for herpes simplex type-1 thymidine kinase, with emphasis on IVFRU, a stable potent and selective HSV-1 TK substrate developed in their laboratories

  16. Transferências lipídicas para HDL em diabéticos tipo 2: associações com microalbuminúria, estatina e insulina Transferencias lipídicas hacia HDL en diabéticos tipo 2: asociaciones con microalbuminuria, estatina y insulina Lipid transfer to HDL in type-2 diabetic patients: associations with microalbuminuria, statin, and insulin

    Directory of Open Access Journals (Sweden)

    Gilson Soares Feitosa-Filho

    2009-02-01

    for coronary artery disease, especially when associated with microalbuminuria (MA. Structural and functional changes in lipoproteins have not yet been fully elucidated in this context. OBJECTIVE: To assess lipid transfer (T to HDL in type-2 diabetic patients and its association with microalbuminuria and treatment with statins or insulin. METHODS: Thirty-three patients with type-2 diabetes mellitus and 34 age-matched control subjects were studied. A synthetic cholesterol-rich nanoemulsion radiolabeled with ³H- triglycerides (TG and 14C-free cholesterol (FC or ³H- cholesteryl ester (CE and 14C-phospholipids (PL was incubated with plasma. Both the nanoemulsion and lipoproteins were precipitated, except for HDL, which was counted for radioactivity. RESULTS: PLT (% was higher in the T2DM group than in the control group (25.2 ± 3.2 and 19.7 ± 3.2 respectively; p < 0.001, as was free cholesterol (% FC: 9.1 ± 2.7 and 6.3 ± 1.5 respectively; p < 0.001. The diagnosis of microalbuminuria (MA was not associated with changes in lipid transfers. Insulin therapy was associated with lower PLT rates: 23.5 ± 2.1 versus 26.1 ± 3.3; p = 0.018. Statin therapy, in turn, was associated with a drop in all lipid transfers - CET 3.5 ± 0.9; PLT: 23.8 ± 2.0; TGT: 3.9 ± 0.8; FCT: 7.4 ± 1.3 - as compared to the group that was not on statin therapy (CET: 5.9 ± 2.4; PLT: 26.9 ± 3.6; TGT: 6.4 ± 2.2; FCT: 11.1 ± 2.6. CONCLUSION:Type-2 diabetes mellitus increased lipid transfer to HDL particles, whereas statin therapy decreased all lipid transfers. The presence of MA was not associated with changes in lipid transfer.

  17. Wireless adiabatic power transfer

    International Nuclear Information System (INIS)

    Rangelov, A.A.; Suchowski, H.; Silberberg, Y.; Vitanov, N.V.

    2011-01-01

    Research highlights: → Efficient and robust mid-range wireless energy transfer between two coils. → The adiabatic energy transfer is analogous to adiabatic passage in quantum optics. → Wireless energy transfer is insensitive to any resonant constraints. → Wireless energy transfer is insensitive to noise in the neighborhood of the coils. - Abstract: We propose a technique for efficient mid-range wireless power transfer between two coils, by adapting the process of adiabatic passage for a coherently driven two-state quantum system to the realm of wireless energy transfer. The proposed technique is shown to be robust to noise, resonant constraints, and other interferences that exist in the neighborhood of the coils.

  18. Radioecology. Transfers of radioelements

    International Nuclear Information System (INIS)

    Foulquier, L.

    2002-01-01

    The study of the cycle of radioelements in the environment requires the measurement of the radionuclides present in all parts of the ecosystems. The knowledge of the mechanisms of radioactive pollutant transfers and of the kinetics of the exchanges between a source term, the vectors and the constituents of the biosphere represents heart of the work of radio-ecologists. This article describes briefly the techniques used for the measurement of radionuclides in the environment and for the study of their physical dispersion mechanisms. Then, it treats more carefully of the transfer mechanisms in different environments: 1 - tools for the evaluation of transfers: metrology, atmospheric and liquid dispersion phenomena; 2 - processes of radioelement transfers: transfers in aquatic ecosystems, transfers in terrestrial environment. (J.S.)

  19. Gas transfer system

    International Nuclear Information System (INIS)

    Oberlin, J.C.; Frick, G.; Kempfer, C.; North, C.

    1988-09-01

    The state of work on the Vivitron gas transfer system and the system functions are summarized. The system has to: evacuate the Vivitron reservoir; transfer gas from storage tanks to the Vivitron; recirculate gas during operation; transfer gas from the Vivitron to storage tanks; and assure air input. The system is now being installed. Leak alarms are given by SF6 detectors, which set off a system of forced ventilation. Another system continuously monitors the amount of SF6 in the tanks [fr

  20. Transfer vibration through spine

    OpenAIRE

    Benyovszky, Adam

    2012-01-01

    Transfer Vibration through Spine Abstract In the bachelor project we deal with the topic of Transfer Vibration through Spine. The problem of TVS is trying to be solved by the critical review method. We analyse some diagnostic methods and methods of treatment based on this principle. Close attention is paid to the method of Transfer Vibration through Spine that is being currently solved by The Research Institute of Thermomechanics in The Czech Academy of Sciences in cooperation with Faculty of...

  1. Nonparametric Transfer Function Models

    Science.gov (United States)

    Liu, Jun M.; Chen, Rong; Yao, Qiwei

    2009-01-01

    In this paper a class of nonparametric transfer function models is proposed to model nonlinear relationships between ‘input’ and ‘output’ time series. The transfer function is smooth with unknown functional forms, and the noise is assumed to be a stationary autoregressive-moving average (ARMA) process. The nonparametric transfer function is estimated jointly with the ARMA parameters. By modeling the correlation in the noise, the transfer function can be estimated more efficiently. The parsimonious ARMA structure improves the estimation efficiency in finite samples. The asymptotic properties of the estimators are investigated. The finite-sample properties are illustrated through simulations and one empirical example. PMID:20628584

  2. Basic heat transfer

    CERN Document Server

    Bacon, D H

    2013-01-01

    Basic Heat Transfer aims to help readers use a computer to solve heat transfer problems and to promote greater understanding by changing data values and observing the effects, which are necessary in design and optimization calculations.The book is concerned with applications including insulation and heating in buildings and pipes, temperature distributions in solids for steady state and transient conditions, the determination of surface heat transfer coefficients for convection in various situations, radiation heat transfer in grey body problems, the use of finned surfaces, and simple heat exc

  3. Containment condensing heat transfer

    International Nuclear Information System (INIS)

    Gido, R.G.; Koestel, A.

    1983-01-01

    This report presents a mechanistic heat-transfer model that is valid for large scale containment heat sinks. The model development is based on the determination that the condensation is controlled by mass diffusion through the vapor-air boundary layer, and the application of the classic Reynolds' analogy to formulate expressions for the transfer of heat and mass based on hydrodynamic measurements of the momentum transfer. As a result, the analysis depends on the quantification of the shear stress (momentum transfer) at the interface between the condensate film and the vapor-air boundary layer. In addition, the currently used Tagami and Uchida test observations and their range of applicability are explained

  4. Counter-transference reactions contributing to completed suicide.

    Science.gov (United States)

    Modestin, J

    1987-12-01

    Counter-transference reactions are frequently elicited while treating suicidal patients and they may contribute to the patient's committing suicide. Therapeutic constellations including the failure of the therapist to (1) cope with the patient's aggressiveness, (2) tolerate the patient's dependency, (3) handle the erotic transference adequately and (4) preserve loyalty towards the patient; they have all been identified as being responsible for a therapeutic impasse with fatal consequences. Knowledge of the therapeutic constellations especially prone to facilitate negative counter-transference reactions may help the therapist to master them effectively.

  5. Application of localized 31P MRS saturation transfer at 7 T for measurement of ATP metabolism in the liver: reproducibility and initial clinical application in patients with non-alcoholic fatty liver disease

    International Nuclear Information System (INIS)

    Valkovic, Ladislav; Gajdosik, Martin; Chmelik, Marek; Trattnig, Siegfried; Traussnigg, Stefan; Kienbacher, Christian; Trauner, Michael; Wolf, Peter; Krebs, Michael; Bogner, Wolfgang; Krssak, Martin

    2014-01-01

    Saturation transfer (ST) phosphorus MR spectroscopy ( 31 P MRS) enables in vivo insight into energy metabolism and thus could identify liver conditions currently diagnosed only by biopsy. This study assesses the reproducibility of the localized 31 P MRS ST in liver at 7 T and tests its potential for noninvasive differentiation of non-alcoholic fatty liver (NAFL) and steatohepatitis (NASH). After the ethics committee approval, reproducibility of the localized 31 P MRS ST at 7 T and the biological variation of acquired hepato-metabolic parameters were assessed in healthy volunteers. Subsequently, 16 suspected NAFL/NASH patients underwent MRS measurements and diagnostic liver biopsy. The Pi-to-ATP exchange parameters were compared between the groups by a Mann-Whitney U test and related to the liver fat content estimated by a single-voxel proton ( 1 H) MRS, measured at 3 T. The mean exchange rate constant (k) in healthy volunteers was 0.31 ± 0.03 s -1 with a coefficient of variation of 9.0 %. Significantly lower exchange rates (p -1 ) when compared to healthy volunteers, and NAFL patients (k = 0.30 ± 0.05 s -1 ). Significant correlation was found between the k value and the liver fat content (r = 0.824, p 31 P MRS ST technique provides a tool for gaining insight into hepatic ATP metabolism and could contribute to the differentiation of NAFL and NASH. (orig.)

  6. The transference neurosis in Freud's writings.

    Science.gov (United States)

    Reed, G S

    1990-01-01

    This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.

  7. Evaluation of the educational technology "Caring for dependent people" by family caregivers in changes and transfers of patients and tube feeding.

    Science.gov (United States)

    Landeiro, Maria José Lumini; Peres, Heloísa Helena Ciqueto; Martins, Teresa Vieira

    2016-08-18

    to assess the contributions of interactive educational technology "Caring for Dependent People" in the development of knowledge to family caregivers of dependent people in a household context and their satisfaction in its use. quasi-experimental study, not randomized, of the before and after type, with a convenience sample of 65 family caregivers, from two Medicine services of a hospital in Porto, Portugal. The Control Group consisted of 33 family caregivers and the Experimental Group of 32, identified by consecutive sampling. The experimental group had access to educational technology at home. Data were collected by socio-demographic, satisfaction and evaluation of knowledge questionnaire, about how to feed by nasogastric tube, positioning and transferring the dependent person. The assessment in both groups had two moments: initial, during hospitalization and one month after discharge. the experimental group had a larger increase in knowledge related to the use of the educational technology. In the control group the knowledge did not differ in the two evaluation time points. these results confirm the improvement of interactive educational technologies and in the training of family caregivers to care for dependents. This technology successfully met the technical quality and learning needs of caregivers, and was considered easy and stimulating. avaliar os contributos da tecnologia educacional interativa "Cuidar de Pessoas Dependentes" no desenvolvimento de conhecimentos aos familiares cuidadores de pessoas dependentes, no contexto domiciliário e a satisfação no seu uso. estudo quasi-experimental, não randomizado, do tipo antes e depois, com amostra de conveniência constituída por 65 familiares cuidadores, de dois Serviços de Medicina de um hospital do Porto, Portugal. O Grupo Controle foi constituído por 33 familiares cuidadores e o Grupo Experimental por 32, identificados por amostragem consecutiva. O grupo experimental teve Acesso à tecnologia educacional

  8. Movimentação e transferência de pacientes: aspectos posturais e ergonômicos Moving and lifting patients: postural and ergonomic aspects

    Directory of Open Access Journals (Sweden)

    Neusa Maria Costa Alexandre

    2000-06-01

    Full Text Available Os procedimentos que envolvem a movimentação e o transporte de pacientes são considerados os mais penosos e perigosos para os trabalhadores de saúde, sendo que a implementação de treinamentos e reciclagem é parte obrigatória de programas de prevenção de lesões músculo-esqueléticas em escolas e instituições de saúde. O presente trabalho descreve orientações básicas e inovadoras sobre esses procedimentos, dentro de uma abordagem ergonômica e com a utilização de materiais auxiliares.The most dangerous and difficult tasks faced by health workers are those procedures involved with lifting and moving patients. Therefore, training and recycling programs in lifting procedures are a compulsory part of programs for the prevention of musculoskeletal disorders in schools and health institutions. The present study presents basic and innovative orientation with an ergonomic approach regarding these procedures, together with the use of devices.

  9. Technology Transfer and Technology Transfer Intermediaries

    Science.gov (United States)

    Bauer, Stephen M.; Flagg, Jennifer L.

    2010-01-01

    A standard and comprehensive model is needed to evaluate and compare technology transfer systems and the stakeholders within these systems. The principle systems considered include federal laboratories, U.S. universities, the rehabilitation engineering research centers (RERCs), and large small business innovation research programs. An earlier…

  10. An Interdistrict Transfer Program

    Science.gov (United States)

    Gross, Norman

    1975-01-01

    This testimony, before the May 1974 public hearings of the New York City Commission on Human Rights by the Administrator, Urban-Suburban Transfer Program and Inter district Transfer Program, West Irondequoit School District, New York, reviews a program which began with 25 minority group youngsters from one racially-imbalanced Rochester school…

  11. Transfer involving deformed nuclei

    International Nuclear Information System (INIS)

    Rasmussen, J.O.; Guidry, M.W.; Canto, L.F.

    1985-03-01

    Results are reviewed of 1- and 2-neutron transfer reactions at near-barrier energies for deformed nuclei. Rotational angular momentum and excitation patterns are examined. A strong tendency to populating high spin states within a few MeV of the yrast line is noted, and it is interpreted as preferential transfer to rotation-aligned states. 16 refs., 12 figs

  12. Sustainable technology transfer

    NARCIS (Netherlands)

    Punter, H.T.; Krikhaar, R.L.; Bril, R.J.

    2006-01-01

    In this position paper we address the issue of transferring a technology from research into an industrial organization by presenting a refined process for technology transfer. Based on over two decades of industrial experience, we identified the need for a dedicated technology engineering phase for

  13. Application of localized {sup 31}P MRS saturation transfer at 7 T for measurement of ATP metabolism in the liver: reproducibility and initial clinical application in patients with non-alcoholic fatty liver disease

    Energy Technology Data Exchange (ETDEWEB)

    Valkovic, Ladislav [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Slovak Academy of Sciences, Department of Imaging Methods, Institute of Measurement Science, Bratislava (Slovakia); Gajdosik, Martin; Chmelik, Marek; Trattnig, Siegfried [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Traussnigg, Stefan; Kienbacher, Christian; Trauner, Michael [Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna (Austria); Wolf, Peter; Krebs, Michael [Medical University of Vienna, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna (Austria); Bogner, Wolfgang [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Krssak, Martin [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Medical University of Vienna, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna (Austria)

    2014-07-15

    Saturation transfer (ST) phosphorus MR spectroscopy ({sup 31}P MRS) enables in vivo insight into energy metabolism and thus could identify liver conditions currently diagnosed only by biopsy. This study assesses the reproducibility of the localized {sup 31}P MRS ST in liver at 7 T and tests its potential for noninvasive differentiation of non-alcoholic fatty liver (NAFL) and steatohepatitis (NASH). After the ethics committee approval, reproducibility of the localized {sup 31}P MRS ST at 7 T and the biological variation of acquired hepato-metabolic parameters were assessed in healthy volunteers. Subsequently, 16 suspected NAFL/NASH patients underwent MRS measurements and diagnostic liver biopsy. The Pi-to-ATP exchange parameters were compared between the groups by a Mann-Whitney U test and related to the liver fat content estimated by a single-voxel proton ({sup 1}H) MRS, measured at 3 T. The mean exchange rate constant (k) in healthy volunteers was 0.31 ± 0.03 s{sup -1} with a coefficient of variation of 9.0 %. Significantly lower exchange rates (p < 0.01) were found in NASH patients (k = 0.17 ± 0.04 s{sup -1}) when compared to healthy volunteers, and NAFL patients (k = 0.30 ± 0.05 s{sup -1}). Significant correlation was found between the k value and the liver fat content (r = 0.824, p < 0.01). Our data suggest that the {sup 31}P MRS ST technique provides a tool for gaining insight into hepatic ATP metabolism and could contribute to the differentiation of NAFL and NASH. (orig.)

  14. Radiative heat transfer

    CERN Document Server

    Modest, Michael F

    2013-01-01

    The third edition of Radiative Heat Transfer describes the basic physics of radiation heat transfer. The book provides models, methodologies, and calculations essential in solving research problems in a variety of industries, including solar and nuclear energy, nanotechnology, biomedical, and environmental. Every chapter of Radiative Heat Transfer offers uncluttered nomenclature, numerous worked examples, and a large number of problems-many based on real world situations-making it ideal for classroom use as well as for self-study. The book's 24 chapters cover the four major areas in the field: surface properties; surface transport; properties of participating media; and transfer through participating media. Within each chapter, all analytical methods are developed in substantial detail, and a number of examples show how the developed relations may be applied to practical problems. It is an extensive solution manual for adopting instructors. Features: most complete text in the field of radiative heat transfer;...

  15. Technology Transfer Issues and a New Technology Transfer Model

    Science.gov (United States)

    Choi, Hee Jun

    2009-01-01

    The following are major issues that should be considered for efficient and effective technology transfer: conceptions of technology, technological activity and transfer, communication channels, factors affecting transfer, and models of transfer. In particular, a well-developed model of technology transfer could be used as a framework for…

  16. Knowledge transfer isn’t simply transfer

    DEFF Research Database (Denmark)

    Dao, Li; Napier, Nancy

    2012-01-01

    This paper examines micro dynamic aspects of knowledge sharing and learning in international joint venture settings. Learning of expatriate and local managers appears far more complex and mutually dependent than conventionally speculated in existing literature. The paper proposes that the effect ...... Danish and Vietnamese firms. The paper suggests that learning in IJVs, even in the context of one-way knowledge transfer from the foreign parent, should be managed in a mutual perspective and with thoughtful coordination of individual learning....... and outcome of knowledge transfer from joint venture parents and learning in IJVs are dependent on how individual managers (including both expatriate and local) learn, perceive their learning roles, and enact a learning agenda. Empirical evidence is drawn from two cases of international joint ventures between...

  17. Transference, counter-transference and repetition: some implications for nursing practice.

    Science.gov (United States)

    Jones, Alun C

    2005-11-01

    This discussion paper offers an introductory text for nurses and explores the psychoanalytic ideas of transference, counter-transference and repetition compulsion. Disguised case vignettes provide illustrations of the ideas as they might apply to nursing, including professional practice and occupational choice. The literature suggests that transference can be a source of creativity as well as destructiveness and influence important communications with oneself and others including the choice of nursing and other health professions as an occupation. Recognizing possibilities of transference, counter-transference along with repetitive patterns of behaviours, can help nurses of all specialities to address situations constructively by responding thoughtfully and appropriately. This discussion concludes with the suggestions that we know little about the motivational factors underlying nursing as an occupational preference; moreover, nursing does not have a culture of personal therapy. As such nurses are denied opportunities to understand the possible reasons underlying their occupational choice or gain experiential knowledge of interpersonal dynamics occurring between patients and colleagues. Transference and counter-transference are thought to have some bearing on all relationships. Forming a natural part of the way human beings relate to each other, transference and counter-transference can bring about sincere human interest, caring and concern. However, there is also potential for disagreements. Recognizing the possible origins of relational difficulties can offer opportunities for professional development to nurses along with the benefits for health service users.

  18. Large momentum transfer phenomena

    International Nuclear Information System (INIS)

    Imachi, Masahiro; Otsuki, Shoichiro; Matsuoka, Takeo; Sawada, Shoji.

    1978-01-01

    The large momentum transfer phenomena in hadron reaction drastically differ from small momentum transfer phenomena, and are described in this paper. Brief review on the features of the large transverse momentum transfer reactions is described in relation with two-body reactions, single particle productions, particle ratios, two jet structure, two particle correlations, jet production cross section, and the component of momentum perpendicular to the plane defined by the incident protons and the triggered pions and transverse momentum relative to jet axis. In case of two-body process, the exponent N of the power law of the differential cross section is a value between 10 to 11.5 in the large momentum transfer region. The breaks of the exponential behaviors into the power ones are observed at the large momentum transfer region. The break would enable to estimate the order of a critical length. The large momentum transfer phenomena strongly suggest an important role of constituents of hadrons in the hard region. Hard rearrangement of constituents from different initial hadrons induces large momentum transfer reactions. Several rules to count constituents in the hard region have been proposed so far to explain the power behavior. Scale invariant quark interaction and hard reactions are explained, and a summary of the possible types of hard subprocess is presented. (Kato, T.)

  19. Technology transfer 1994

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This document, Technology Transfer 94, is intended to communicate that there are many opportunities available to US industry and academic institutions to work with DOE and its laboratories and facilities in the vital activity of improving technology transfer to meet national needs. It has seven major sections: Introduction, Technology Transfer Activities, Access to Laboratories and Facilities, Laboratories and Facilities, DOE Office, Technologies, and an Index. Technology Transfer Activities highlights DOE`s recent developments in technology transfer and describes plans for the future. Access to Laboratories and Facilities describes the many avenues for cooperative interaction between DOE laboratories or facilities and industry, academia, and other government agencies. Laboratories and Facilities profiles the DOE laboratories and facilities involved in technology transfer and presents information on their missions, programs, expertise, facilities, and equipment, along with data on whom to contact for additional information on technology transfer. DOE Offices summarizes the major research and development programs within DOE. It also contains information on how to access DOE scientific and technical information. Technologies provides descriptions of some of the new technologies developed at DOE laboratories and facilities.

  20. Dexter energy transfer pathways.

    Science.gov (United States)

    Skourtis, Spiros S; Liu, Chaoren; Antoniou, Panayiotis; Virshup, Aaron M; Beratan, David N

    2016-07-19

    Energy transfer with an associated spin change of the donor and acceptor, Dexter energy transfer, is critically important in solar energy harvesting assemblies, damage protection schemes of photobiology, and organometallic opto-electronic materials. Dexter transfer between chemically linked donors and acceptors is bridge mediated, presenting an enticing analogy with bridge-mediated electron and hole transfer. However, Dexter coupling pathways must convey both an electron and a hole from donor to acceptor, and this adds considerable richness to the mediation process. We dissect the bridge-mediated Dexter coupling mechanisms and formulate a theory for triplet energy transfer coupling pathways. Virtual donor-acceptor charge-transfer exciton intermediates dominate at shorter distances or higher tunneling energy gaps, whereas virtual intermediates with an electron and a hole both on the bridge (virtual bridge excitons) dominate for longer distances or lower energy gaps. The effects of virtual bridge excitons were neglected in earlier treatments. The two-particle pathway framework developed here shows how Dexter energy-transfer rates depend on donor, bridge, and acceptor energetics, as well as on orbital symmetry and quantum interference among pathways.

  1. Fast multilevel radiative transfer

    Science.gov (United States)

    Paletou, Frédéric; Léger, Ludovick

    2007-01-01

    The vast majority of recent advances in the field of numerical radiative transfer relies on approximate operator methods better known in astrophysics as Accelerated Lambda-Iteration (ALI). A superior class of iterative schemes, in term of rates of convergence, such as Gauss-Seidel and Successive Overrelaxation methods were therefore quite naturally introduced in the field of radiative transfer by Trujillo Bueno & Fabiani Bendicho (1995); it was thoroughly described for the non-LTE two-level atom case. We describe hereafter in details how such methods can be generalized when dealing with non-LTE unpolarised radiation transfer with multilevel atomic models, in monodimensional geometry.

  2. A heat transfer textbook

    CERN Document Server

    Lienhard, John H

    2011-01-01

    This introduction to heat transfer offers advanced undergraduate and graduate engineering students a solid foundation in the subjects of conduction, convection, radiation, and phase-change, in addition to the related topic of mass transfer. A staple of engineering courses around the world for more than three decades, it has been revised and updated regularly by the authors, a pair of recognized experts in the field. The text addresses the implications, limitations, and meanings of many aspects of heat transfer, connecting the subject to its real-world applications and developing students' ins

  3. Excavating a transfer tunnel

    CERN Multimedia

    Laurent Guiraud

    2000-01-01

    The transfer tunnel being dug here will take the 450 GeV beam from the SPS and inject it into the LHC where the beam energies will be increased to 7 TeV. In order to transfer this beam from the SPS to the LHC, two transfer tunnels are used to circulate the beams in opposite directions. When excavated, the accelerator components, including magnets, beam pipes and cryogenics will be installed and connected to both the SPS and LHC ready for operation to begin in 2008.

  4. Comparisons of power transfer functions and flow transfer functions

    International Nuclear Information System (INIS)

    Grimm, K.N.; Meneghetti, D.

    1987-01-01

    Transfer functions may be used to calculate component feedbacks or temperature increments by convolution of the transfer function with the appropriate fractional change in system-quantity. Power-change transfer functions have been reported. The corresponding flow transfer functions for this case, and comparison with the power transfer functions, are reported here. Results of feedback simulation of ramped flow transients using flow transfer functions are also described

  5. Emerging quinolones resistant transfer genes among gram-negative bacteria, isolated from faeces of HIV/AIDS patients attending some Clinics and Hospitals in the City of Benin, Edo State, Nigeria

    Directory of Open Access Journals (Sweden)

    Enabulele IO

    2006-12-01

    Full Text Available A survey of 1431 gram-negative bacilli from June 2001 to September 2005 were obtained from the faeces of 920 HIV/AIDS patients attending some Clinics and Hospitals in Benin City, Nigeria, were screened for quinolones resistance gene. The HIV/AIDS patients CD4 cells range was ≤14/mm3 ≥800/mm3 of blood. Out of the 1431 isolates, 343 (23.9% were resistance to quinolones with a MIC ≥4μg/ml for norfloxacin, ciprofloxacin and pefloxacin while a MIC of ≥32 µg/ml for nalidixic acid. The screened isolates include Pseudomonas aeruginosa 64(18.7%, E coli 92(26.8%, Klebsiella pneumoniae 53(15.4%, Salmonella typhi 39(11.4%, Shigella dysenteriae 36(10.5%, Proteus mirabilis 34(9.9% and Serratia marcescens 25(7.3%. The average resistance of the isolates to the various quinolones ranged from 42.7% to 66.7%. Klebsiella were the most resistant isolates with a mean resistance of 66.7% while Proteus were the less resistant isolates with a mean resistance of 42.7%. Most isolates were resistant to Nalidixic acid followed by norfloxacin while the less resistant were to the pefloxacin. The frequency of qnr genes transfer to EJRifr as recipient ranged from 2 x 10-2 to 6 x 10-6 with an average of 2 plasmids per cell. The molecular weight of the plasmids ranged from <2.9kbp to <5.5 kbp. This indicated that plasmids allowed the movement of genetic materials including qnr resistant genes between bacteria species and genera in Benin City, Nigeria.

  6. Liquefied Natural Gas Transfer

    Science.gov (United States)

    1980-01-01

    Chicago Bridge & Iron Company's tanks and associated piping are parts of system for transferring liquefied natural gas from ship to shore and storing it. LNG is a "cryogenic" fluid meaning that it must be contained and transferred at very low temperatures, about 260 degrees below Fahrenheit. Before the LNG can be pumped from the ship to the storage tanks, the two foot diameter transfer pipes must be cooled in order to avoid difficulties associated with sharp differences of temperature between the supercold fluid and relatively warm pipes. Cooldown is accomplished by sending small steady flow of the cryogenic substance through the pipeline; the rate of flow must be precisely controlled or the transfer line will be subjected to undesirable thermal stress.

  7. Electron transfer in proteins

    DEFF Research Database (Denmark)

    Farver, O; Pecht, I

    1991-01-01

    Electron migration between and within proteins is one of the most prevalent forms of biological energy conversion processes. Electron transfer reactions take place between active centers such as transition metal ions or organic cofactors over considerable distances at fast rates and with remarkable...... specificity. The electron transfer is attained through weak electronic interaction between the active sites, so that considerable research efforts are centered on resolving the factors that control the rates of long-distance electron transfer reactions in proteins. These factors include (in addition......-containing proteins. These proteins serve almost exclusively in electron transfer reactions, and as it turns out, their metal coordination sites are endowed with properties uniquely optimized for their function....

  8. Industrial technology transfer

    International Nuclear Information System (INIS)

    Bulger, W.

    1982-06-01

    The transfer of industrial technology is an essential part of the CANDU export marketing program. Potential customers require the opportunity to become self-sufficient in the supply of nuclear plant and equipment in the long term and they require local participation to the maximum extent possible. The Organization of CANDU Industries is working closely with Atomic Energy of Canada Ltd. in developing comprehensive programs for the transfer of manufacturing technology. The objectives of this program are: 1) to make available to the purchasing country all nuclear component manufacturing technology that exists in Canada; and 2) to assure that the transfer of technology takes place in an efficient and effective way. Technology transfer agreements may be in the form of joint ventures or license agreements, depending upon the requirements of the recipient

  9. Fast multilevel radiative transfer

    International Nuclear Information System (INIS)

    Paletou, Frederic; Leger, Ludovick

    2007-01-01

    The vast majority of recent advances in the field of numerical radiative transfer relies on approximate operator methods better known in astrophysics as Accelerated Lambda-Iteration (ALI). A superior class of iterative schemes, in term of rates of convergence, such as Gauss-Seidel and successive overrelaxation methods were therefore quite naturally introduced in the field of radiative transfer by Trujillo Bueno and Fabiani Bendicho [A novel iterative scheme for the very fast and accurate solution of non-LTE radiative transfer problems. Astrophys J 1995;455:646]; it was thoroughly described for the non-LTE two-level atom case. We describe hereafter in details how such methods can be generalized when dealing with non-LTE unpolarised radiation transfer with multilevel atomic models, in monodimensional geometry

  10. Technology transfer quality assurance

    International Nuclear Information System (INIS)

    Hood, F.C.

    1991-03-01

    The results of research conducted at Pacific Northwest Laboratory (PNL) for the DOE are regularly transferred from the laboratory to the private sector. The principal focus of PNL is on environmental research and waste management technology; other programs of emphasis include molecular science research. The technology transfer process is predicated on Quality to achieve its objectives effectively. Total quality management (TQM) concepts and principles readily apply to the development and translation of new scientific concepts into commercial products. The concept of technology transfer epitomizes the TQM tenet of continuous improvement: always striving for a better way to do things and always satisfying the customer. A successful technology transfer process adds value to society by providing new or enhanced processes, products, and services to government and commercial customers, with a guarantee of product pedigree and process validity. 2 refs

  11. Analytical heat transfer

    CERN Document Server

    Han, Je-Chin

    2012-01-01

    … it will complete my library … [and] complement the existing literature on heat transfer. It will be of value for both graduate students and faculty members.-Bengt Sunden, Lund University, Sweden

  12. Technology transfer for adaptation

    Science.gov (United States)

    Biagini, Bonizella; Kuhl, Laura; Gallagher, Kelly Sims; Ortiz, Claudia

    2014-09-01

    Technology alone will not be able to solve adaptation challenges, but it is likely to play an important role. As a result of the role of technology in adaptation and the importance of international collaboration for climate change, technology transfer for adaptation is a critical but understudied issue. Through an analysis of Global Environment Facility-managed adaptation projects, we find there is significantly more technology transfer occurring in adaptation projects than might be expected given the pessimistic rhetoric surrounding technology transfer for adaptation. Most projects focused on demonstration and early deployment/niche formation for existing technologies rather than earlier stages of innovation, which is understandable considering the pilot nature of the projects. Key challenges for the transfer process, including technology selection and appropriateness under climate change, markets and access to technology, and diffusion strategies are discussed in more detail.

  13. Controlled Environment Specimen Transfer

    DEFF Research Database (Denmark)

    Damsgaard, Christian Danvad; Zandbergen, Henny W.; Hansen, Thomas Willum

    2014-01-01

    an environmental transmission electron microscope to an in situ X-ray diffractometer through a dedicated transmission electron microscope specimen transfer holder, capable of sealing the specimen in a gaseous environment at elevated temperatures. Two catalyst material systems have been investigated; Cu/ZnO/Al2O3...... transferred in a reactive environment to the environmental transmission electron microscope where further analysis on the local scale were conducted. The Co/Al2O3 catalyst was reduced in the environmental microscope and successfully kept reduced outside the microscope in a reactive environment. The in situ......Specimen transfer under controlled environment conditions, such as temperature, pressure, and gas composition, is necessary to conduct successive complementary in situ characterization of materials sensitive to ambient conditions. The in situ transfer concept is introduced by linking...

  14. Pneumatic transfer systems

    International Nuclear Information System (INIS)

    Bichler, H.; Boeck, H.; Hammer, J.; Buchtela, K.

    1988-11-01

    A pneumatic transfer system for research reactors, including a sample changer system and to be used for neutron activation analysis, is described. The system can be obtained commercially from the Atominstitut. 2 figs. (qui)

  15. Prospective evaluation of basal stromal Doppler studies in women with good ovarian reserve and infertility undergoing in vitro fertilization-embryo transfer treatment: patients with polycystic ovary syndrome versus ovulatory patients.

    Science.gov (United States)

    Younis, Johnny S; Jadaon, Jimmy E; Haddad, Sami; Izhaki, Ido; Ben-Ami, Moshe

    2011-04-01

    To gain insight into the ovarian stromal blood flow in women with polycystic ovary syndrome (PCOS) as compared with women with normal ovulation, good ovarian reserve, and infertility and to evaluate the role of stromal flow in these patients to predict clinical pregnancy in an assisted reproductive technologies setting. A prospective observational cohort study. A university-affiliated reproductive medicine unit. Eighteen consecutive patients with PCOS (study) compared with 101 patients with normal ovulation and infertility (control), undergoing their first IVF-ET treatment at our unit. Women with low ovarian reserve were excluded a priori from evaluation. Basal ovarian reserve parameters and stromal flow studies were conducted as routinely performed in our unit, in a natural cycle before starting treatment. None. Basal ovarian endocrine, sonographic, and stromal flow studies were compared between the groups. After completion of treatment, the stromal flow studies were compared between conception and nonconception cycles. Patients' characteristics and basal ovarian reserve, including endocrine and sonographic parameters, were similar between the PCOS and control groups. Only antral follicle count and LH/FSH ratio were higher in the PCOS as compared with the control group, corresponding to 15.11 ± 6.05 versus 9.05 ± 4.77 and 1.14 ± 0.64 versus 0.79 ± 0.37, respectively. Basal stromal flow indices were similar between the PCOS group and the group with normal ovulation and good ovarian reserve. Clinical pregnancy rate per initiated cycle was 50.0% and 39.6% in the PCOS and control groups, respectively, with no significant difference. Flow indices were similar between conception cycles in the PCOS and control groups. As well, the indices did not differ significantly between conception and nonconception cycles within the PCOS and control groups. Basal ovarian stromal blood flow does not differ between women with PCOS and women with normal ovulation, good ovarian

  16. Theories Supporting Transfer of Training.

    Science.gov (United States)

    Yamnill, Siriporn; McLean, Gary N.

    2001-01-01

    Reviews theories about factors affecting the transfer of training, including theories on motivation (expectancy, equity, goal setting), training transfer design (identical elements, principle, near and far), and transfer climate (organizational). (Contains 36 references.) (SK)

  17. Convection heat transfer

    CERN Document Server

    Bejan, Adrian

    2013-01-01

    Written by an internationally recognized authority on heat transfer and thermodynamics, this second edition of Convection Heat Transfer contains new and updated problems and examples reflecting real-world research and applications, including heat exchanger design. Teaching not only structure but also technique, the book begins with the simplest problem solving method (scale analysis), and moves on to progressively more advanced and exact methods (integral method, self similarity, asymptotic behavior). A solutions manual is available for all problems and exercises.

  18. Credit risk transfer

    OpenAIRE

    Bank for International Settlements

    2003-01-01

    Executive summary Techniques for transferring credit risk, such as financial guarantees and credit insurance, have been a long-standing feature of financial markets. In the past few years, however, the range of credit risk transfer (CRT) instruments and the circumstances in which they are used have widened considerably. A number of factors have contributed to this growth, including: greater focus by banks and other financial institutions on risk management; a more rigorous approach to risk/re...

  19. Heat transfer II essentials

    CERN Document Server

    REA, The Editors of

    1988-01-01

    REA's Essentials provide quick and easy access to critical information in a variety of different fields, ranging from the most basic to the most advanced. As its name implies, these concise, comprehensive study guides summarize the essentials of the field covered. Essentials are helpful when preparing for exams, doing homework and will remain a lasting reference source for students, teachers, and professionals. Heat Transfer II reviews correlations for forced convection, free convection, heat exchangers, radiation heat transfer, and boiling and condensation.

  20. Transfer og effekt

    DEFF Research Database (Denmark)

    Sørensen, Peter

    2017-01-01

    Effekt, virkning eller udbytte af en lederuddannelse afhænger af en række individuelle, uddannelsesmæssige og organisatoriske faktorer. Det ved vi fra uddannelsesforskningen og særligt fra forskningen i transfer. Kun hvis uddannelsesinstitutionerne såvel som de studerende og arbejdspladserne vil...... medvirke aktivt til at skabe og fremme transfer, kan man gøre sig forhåbninger om, at få effekt af en lederuddannelse....

  1. Advances in heat transfer

    CERN Document Server

    Hartnett, James P; Cho, Young I; Greene, George A

    2001-01-01

    Heat transfer is the exchange of heat energy between a system and its surrounding environment, which results from a temperature difference and takes place by means of a process of thermal conduction, mechanical convection, or electromagnetic radiation. Advances in Heat Transfer is designed to fill the information gap between regularly scheduled journals and university-level textbooks by providing in-depth review articles over a broader scope than is allowable in either journals or texts.

  2. Effective Bayesian Transfer Learning

    Science.gov (United States)

    2010-03-01

    the class of algorithms analyzed by Bartlett’s work under task R4). With emphasis on transferring one type of objects to another, (e.g., coffee cups...obstacles, so those are temporarily pruned from the graph. In addition, the start and goal locations may not be currently included in the graph. They carried...Transfer Level 3 Varying shape within class Task A: Instances of an object from the same class. ( Coffee mug) Task B: Instances of a different object

  3. Shielded cells transfer automation

    International Nuclear Information System (INIS)

    Fisher, J.J.

    1984-01-01

    Nuclear waste from shielded cells is removed, packaged, and transferred manually in many nuclear facilities. Radiation exposure is absorbed by operators during these operations and limited only through procedural controls. Technological advances in automation using robotics have allowed a production waste removal operation to be automated to reduce radiation exposure. The robotic system bags waste containers out of glove box and transfers them to a shielded container. Operators control the system outside the system work area via television cameras. 9 figures

  4. Heat transfer bibliography: russian works

    Energy Technology Data Exchange (ETDEWEB)

    Luikov, A V

    1965-02-01

    This bibliography of recent Russian publications in heat transfer is divided into the following categories: (1) books; (2) general; (3) experimental methods; (4) analytical calculation methods; (5) thermodynamics; (6) transfer processes involving phase conversions; ((7) transfer processes involving chemical conversions; (8) transfer processes involving very high velocities; (9) drying processes; (10) thermal properties of various materials, heat transfer agents and their determination methods; (11) high temperature physics and magneto- hydrodynamics; and (12) transfer processes in technological apparatuses. (357 refs.)

  5. A conceptual model of transference and its psychotherapeutic application.

    Science.gov (United States)

    Corradi, Richard B

    2006-01-01

    The tendency to repeat formative human relationships in later life, a universal developmental characteristic, is referred to as transference when it occurs in the doctor-patient relationship. Its systematic therapeutic application in psychiatry has historically been associated with classical psychoanalysis. As psychoanalysis has lost its cachet, and as drug treatment has replaced psychotherapy as psychiatry's major treatment modality, the therapeutic potential of transference risks being neglected. This is to the great detriment of psychiatric patients. Knowledge of the power of transference and expertise in its clinical use in psychotherapy should be the most powerful tool in the psychiatric therapeutic armamentarium. This article discusses a concept of transference that the author has found effective, both in clinical practice and in teaching about transference to psychiatric residents. The article delineates a psychology of transference, discusses its universal applicability to the whole of the psychotherapeutic process, and utilizes case material to illustrate principles of its application.

  6. TRANSFER FROM PEDIATRIC TO ADULT ENDOCRINOLOGY.

    Science.gov (United States)

    Jones, Marybeth R; Robbins, Brett W; Augustine, Marilyn; Doyle, Jackie; Mack-Fogg, Jean; Jones, Heather; White, Patience H

    2017-07-01

    Adult and pediatric endocrinologists share responsibility for the transition of youth with type 1 diabetes from pediatric to adult healthcare. This study aimed to increase successful transfers to adult care in subspecialty practices by establishing a systematic health care transition (HCT) process. Providers from the adult and pediatric endocrinology divisions at the University of Rochester Medical Center met monthly to customize and integrate the Six Core Elements (6CEs) of HCT into clinical workflows. Young adult patients with type 1 diabetes having an outpatient visit during a 34-month pre-post intervention period were eligible (N = 371). Retrospective chart review was performed on patients receiving referrals to adult endocrinology (n = 75) to obtain (1) the proportion of patients explicitly tracked during transfer from the pediatric to adult endocrinology practice, (2) the providers' documentation of the use of the 6CEs, and (3) the patients' diabetes control and healthcare utilization during the transition period. The percent of eligible patients with type 1 diabetes who were explicitly tracked in their transfer more than doubled compared to baseline (11% vs. 27% of eligible patients; P<.01). Pediatric providers started to use transition readiness assessments and create medical summaries, and adult providers increased closed-loop communication with pediatric providers after a patient's first adult visit. Glycemic control and healthcare utilization remained stable. Successful implementation of the 6CEs into pediatric and adult subspecialty practices can result in improvements of planned transfers of pediatric patients with type 1 diabetes to adult subspecialty providers. 6CEs = six core elements; AYA = adolescent and young adult; DKA = diabetic ketoacidosis; ED = emergency department; HbA1c = hemoglobin A1c; HCT = health care transition.

  7. Electrophoretic transfer protein zymography.

    Science.gov (United States)

    Pan, Daniel; Hill, Adam P; Kashou, Anthony; Wilson, Karl A; Tan-Wilson, Anna

    2011-04-15

    Zymography detects and characterizes proteolytic enzymes by electrophoresis of protease-containing samples into a nonreducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) gel containing a copolymerized protein substrate. The usefulness of zymography for molecular weight determination and proteomic analysis is hampered by the fact that some proteases exhibit slower migration through a gel that contains substrate protein. This article introduces electrophoretic transfer protein zymography as one solution to this problem. In this technique, samples containing proteolytic enzymes are first resolved in nonreducing SDS-PAGE on a gel without protein substrate. The proteins in the resolving gel are then electrophoretically transferred to a receiving gel previously prepared with a copolymerized protein substrate. The receiving gel is then developed as a zymogram to visualize clear or lightly stained bands in a dark background. Band intensities are linearly related to the amount of protease, extending the usefulness of the technique so long as conditions for transfer and development of the zymogram are kept constant. Conditions of transfer, such as the pore sizes of resolving and receiving gels and the transfer time relative to the molecular weight of the protease, are explored. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. University Technology Transfer

    Directory of Open Access Journals (Sweden)

    Mike Cox

    2004-09-01

    Full Text Available This article describes the experiences and general observations of the author at Heriot-Watt University and concerns the transfer of university technology for the purposes of commercialisation. Full commercial exploitation of a university invention generally requires transferring that technology into the industrial arena, usually either by formation of a new company or licensing into an existing company. Commercialisation activities need to be carried out in unison with the prime activities of the university of research and teaching. Responsibility for commercialising university inventions generally rests with a specific group within the university, typically referred to as the technology transfer group. Each technology transfer should be considered individually and appropriate arrangements made for that particular invention. In general, this transfer process involves four stages: identification, evaluation, protection and exploitation. Considerations under these general headings are outlined from a university viewpoint. A phased approach is generally preferred where possible for the evaluation, protection and exploitation of an invention to balance risk with potential reward. Evaluation of the potential opportunity for a university invention involves essentially the same considerations as for an industrial invention. However, there are a range of commercial exploitation routes and potential deals so that only general guidelines can be given. Naturally, the final deal achieved is that which can be negotiated. The potential rewards for the university and inventor are both financial (via licensing income and equity realisation and non-financial.

  9. Photoelectric transfer device

    Energy Technology Data Exchange (ETDEWEB)

    Shinomiya, Takuji; Murao, Fumihide

    1987-12-07

    Concerning the conventional photoelectric transfer device, a short-circuit current of photodiodes is switched over with MOS transistors. However, since the backgate voltage of the MOS transistor which is to be used as the switching element, is provided by the source voltage, the leakage current between the backgate and the source/drain/ channel is great and due to this leakage current, errors occur in the photoelectric transfer power output. Especially, when the leakage current of the photodiodes is small, the error becomes large. In order to solve the above problem, this invention aims at offering a photoelectric transfer device which can provide the high precision photoelectric transfer even the short-circuit current generated in the photodiodes is small and proposes a photoelectric transfer device in which the backgate voltage of the MOS transistor switching over the short-circuit current of the photodiodes is made equal to the electric potential of the mutually connected anodes (or cathodes) of the photodiodes. (3 figs)

  10. Actividad de la proteína transportadora de ésteres de colesterol. Polimorfismos del gen en pacientes colombianos con enfermedad coronaria Activity of cholesteryl ester transfer protein. Gene polymorphism in colombian patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Alejandra M Giraldo

    2012-08-01

    Full Text Available Introducción: la literatura relaciona la actividad de la proteína transportadora de ésteres de colesterol (CETP con enfermedad coronaria, por reducir el colesterol en las lipoproteínas de alta densidad. Adicionalmente, estudios recientes han identificado variaciones en el gen de la CETP, aunque el papel funcional de algunas de estas variantes sobre la actividad enzimática y la enfermedad coronaria, es desconocido. Objetivos: examinar la asociación de los polimorfismos TaqIB, MspI y RsaI del gen de la CETP y la actividad de la enzima con enfermedad coronaria. Métodos: se evaluó la asociación entre la actividad de la enzima y los polimorfismos TaqIB, MspI y RsaI, en pacientes con obstrucción coronaria documentada por angiografía. Resultados: la angiografía permitió clasificar a los pacientes en dos grupos: uno (213 individuos con obstrucción coronaria no significativa (OC 50%. La edad fue significantemente mayor en el último grupo en comparación con el primero. La actividad de la CETP fue 95,8 y 94,7 pmol/μL.h, para los grupos OC 50%, respectivamente. Solo se encontró diferencia significativa entre los alelos M1 y M2 en la población general. Conclusión: no se halló asociación entre la actividad de la CETP, los polimorfismos TaqBI, MspI, Rsal y la obstrucción coronaria. En este trabajo se describen por primera vez los niveles de CETP en los polimorfismos TaqIB, MspI, Rsal para un grupo de pacientes colombianos. Se debe refinar la descripción del evento coronario, el contexto metabólico de los pacientes y el estudio de haplotipos para encontrar relaciones con enfermedad coronaria.Introduction: literature links the activity of cholesteryl ester transfer protein (CETP with coronary heart disease by lowering cholesterol in high density lipoproteins. Additionally, recent studies have identified variations in the CETP gene, although the functional role of some of these variants on enzyme activity and coronary heart disease is

  11. Heat and mass transfer

    CERN Document Server

    Karwa, Rajendra

    2017-01-01

    This textbook presents the classical treatment of the problems of heat transfer in an exhaustive manner with due emphasis on understanding of the physics of the problems. This emphasis is especially visible in the chapters on convective heat transfer. Emphasis is laid on the solution of steady and unsteady two-dimensional heat conduction problems. Another special feature of the book is a chapter on introduction to design of heat exchangers and their illustrative design problems. A simple and understandable treatment of gaseous radiation has been presented. A special chapter on flat plate solar air heater has been incorporated that covers thermo-hydraulic modeling and simulation. The chapter on mass transfer has been written looking specifically at the needs of the students of mechanical engineering. The book includes a large number and variety of solved problems with supporting line diagrams. The author has avoided duplicating similar problems, while incorporating more application-based examples. All the end-...

  12. Quadrupolar transfer pathways

    Science.gov (United States)

    Antonijevic, Sasa; Bodenhausen, Geoffrey

    2006-06-01

    A set of graphical conventions called quadrupolar transfer pathways is proposed to describe a wide range of experiments designed for the study of quadrupolar nuclei with spin quantum numbers I = 1, 3/2, 2, 5/2, etc. These pathways, which inter alea allow one to appreciate the distinction between quadrupolar and Zeeman echoes, represent a generalization of the well-known coherence transfer pathways. Quadrupolar transfer pathways not merely distinguish coherences with different orders -2 I ⩽ p ⩽ +2 I, but allow one to follow the fate of coherences associated with single transitions that have the same coherence orderp=mIr-mIs but can be distinguished by a satellite orderq=(mIr)2-(mIs)2.

  13. Thermal radiation heat transfer

    CERN Document Server

    Howell, John R; Mengüç, M Pinar

    2011-01-01

    Providing a comprehensive overview of the radiative behavior and properties of materials, the fifth edition of this classic textbook describes the physics of radiative heat transfer, development of relevant analysis methods, and associated mathematical and numerical techniques. Retaining the salient features and fundamental coverage that have made it popular, Thermal Radiation Heat Transfer, Fifth Edition has been carefully streamlined to omit superfluous material, yet enhanced to update information with extensive references. Includes four new chapters on Inverse Methods, Electromagnetic Theory, Scattering and Absorption by Particles, and Near-Field Radiative Transfer Keeping pace with significant developments, this book begins by addressing the radiative properties of blackbody and opaque materials, and how they are predicted using electromagnetic theory and obtained through measurements. It discusses radiative exchange in enclosures without any radiating medium between the surfaces-and where heat conduction...

  14. Diffusion and mass transfer

    CERN Document Server

    Vrentas, James S

    2013-01-01

    The book first covers the five elements necessary to formulate and solve mass transfer problems, that is, conservation laws and field equations, boundary conditions, constitutive equations, parameters in constitutive equations, and mathematical methods that can be used to solve the partial differential equations commonly encountered in mass transfer problems. Jump balances, Green’s function solution methods, and the free-volume theory for the prediction of self-diffusion coefficients for polymer–solvent systems are among the topics covered. The authors then use those elements to analyze a wide variety of mass transfer problems, including bubble dissolution, polymer sorption and desorption, dispersion, impurity migration in plastic containers, and utilization of polymers in drug delivery. The text offers detailed solutions, along with some theoretical aspects, for numerous processes including viscoelastic diffusion, moving boundary problems, diffusion and reaction, membrane transport, wave behavior, sedime...

  15. Intergenerational Knowledge Transfer

    International Nuclear Information System (INIS)

    Grover, R.B.

    2016-01-01

    Full text: Institutions of higher education and universities have been at the forefront of intergenerational knowledge transfer. Their role has gone through evolution and several ideas of the university co-exist. Factors like the squeeze on public funding of higher education across nations, exhortation by governments to value work-based learning as a part of higher education and demand for graduates ready to start working immediately on joining a workplace, are making it necessary to further evolve the classical approach towards intergenerational knowledge transfer. The paper presents a framework that has been evolved in India to meet the requirements of intergenerational knowledge transfer. It essentially integrates a workplace and a university in a single entity similar to the practice in medical education. (author

  16. Charge transfer in astrophysical nebulae

    International Nuclear Information System (INIS)

    Shields, G.A.

    1990-01-01

    Charge transfer has become a standard ingredient in models of ionized nebulae, supernovae remnants and active galactic nuclei. Charge transfer rate coefficients and the physics of ionized nebulae are considered. Charge transfer is applied to the ionization structure and line emission of ionized nebulae. Photoionized nebulae observations are used to test theoretical predictions of charge transfer rates. (author)

  17. Engineering heat transfer

    International Nuclear Information System (INIS)

    Welty, J.R.

    1974-01-01

    The basic concepts of heat transfer are covered with special emphasis on up-to-date techniques for formulating and solving problems in the field. The discussion progresses logically from phenomenology to problem solving, and treats numerical, integral, and graphical methods as well as traditional analytical ones. The book is unique in its thorough coverage of the fundamentals of numerical analysis appropriate to solving heat transfer problems. This coverage includes several complete and readable examples of numerical solutions, with discussions and interpretations of results. The book also contains an appendix that provides students with physical data for often-encountered materials. An index is included. (U.S.)

  18. Transferences of Purkinje systems

    Directory of Open Access Journals (Sweden)

    W. F. Harris

    2011-12-01

    Full Text Available The transferences of heterocentric astigmatic Purkinje systems are special: submatrices B and C, that is, the disjugacy and the divergence of the system, are symmetric and submatrix D (the divarication is the transpose of submatrix A (the dilation.  It is the primary purpose of this paper to provide a proof.  The paper also derives other relationships among the fundamental properties and compact expressions for the transference and optical axis locator of a Purkinje system. (S Afr Optom 2011 70(2 57-60

  19. Elementary heat transfer analysis

    CERN Document Server

    Whitaker, Stephen; Hartnett, James P

    1976-01-01

    Elementary Heat Transfer Analysis provides information pertinent to the fundamental aspects of the nature of transient heat conduction. This book presents a thorough understanding of the thermal energy equation and its application to boundary layer flows and confined and unconfined turbulent flows. Organized into nine chapters, this book begins with an overview of the use of heat transfer coefficients in formulating the flux condition at phase interface. This text then explains the specification as well as application of flux boundary conditions. Other chapters consider a derivation of the tra

  20. Cernavoda NPP Knowledge Transfer

    International Nuclear Information System (INIS)

    Valache, C. M.

    2016-01-01

    Full text: The paper presents a description of the Knowledge Transfer (KT) process implemented at Cernavoda NPP, its designing and implementation. It is underlined that applying a KT approach should improve the value of existing processes of the organization through: • Identifying business, operational and safety risks due to knowledge gaps, • Transfer of knowledge from the ageing workforce to the peers and/or the organization, • Continually learning from successes and failures of individual or teams, • Convert tacit knowledge to explicit knowledge, • Improving operational and safety performance through creating both new knowledge and better access to existing knowledge. (author

  1. Thermal transfer recording media

    Science.gov (United States)

    Takei, T.; Taniguchi, M.; Fukushima, H.; Yamaguchi, Y.; Shinozuka, M.; Seikohsha, K. K. Suwa

    1988-08-01

    The recording media consist of more than or one coloring layer and a layer containing a flame retardant to ensure noncombustibility and good thermal transfer. Thus, a PET film was coated on a side with a compound containing Vylon 290 (polyester resin), AFR-1021 (decabromodiphenyl oxide) 8 and Polysafe 60 (Sb oxide), and coated on the other side with a compound containing carnauba wax, HNP-9 (paraffin wax), EV-410 (ethylene-vinyl acetate copolymer), and Cu phthalocyanine to give a thermal transfer recording medium which showed good noncombustibility and antiblocking properties, and provided high quality images.

  2. Knowledge Transfers in IJVs

    DEFF Research Database (Denmark)

    Park, Chansoo; Vertinsky, Ilan; Minbaeva, Dana

    firms to their international joint ventures (IJVs) in South Korea. We developed a theoretical model that examines the impacts of the knowledge senders¡¯ disseminative capacities on knowledge transfer to IJVs. We tested our theory with data from 199 IJVs in South Korea. We found that the willingness...... of parent firms to share knowledge is manifested in an increased capacity to articulate and codify knowledge and create opportunities to transfer this knowledge. Mediated by the effective use of organizational communication channels, articulation and codification capabilities have a significant impact...

  3. Ariane transfer vehicle scenario

    Science.gov (United States)

    Deutscher, Norbert; Cougnet, Claude

    1990-10-01

    ESA's Ariane Transfer Vehicle (ATV) is a vehicle design concept for the transfer of payloads from Ariane 5 launch vehicle orbit insertion to a space station, on the basis of the Ariane 5 program-developed Upper Stage Propulsion Module and Vehicle Equipment Bay. The ATV is conceived as a complement to the Hermes manned vehicle for lower cost unmanned carriage of logistics modules and other large structural elements, as well as waste disposal. It is also anticipated that the ATV will have an essential role in the building block transportation logistics of any prospective European space station.

  4. NASA Technology Transfer System

    Science.gov (United States)

    Tran, Peter B.; Okimura, Takeshi

    2017-01-01

    NTTS is the IT infrastructure for the Agency's Technology Transfer (T2) program containing 60,000+ technology portfolio supporting all ten NASA field centers and HQ. It is the enterprise IT system for facilitating the Agency's technology transfer process, which includes reporting of new technologies (e.g., technology invention disclosures NF1679), protecting intellectual properties (e.g., patents), and commercializing technologies through various technology licenses, software releases, spinoffs, and success stories using custom built workflow, reporting, data consolidation, integration, and search engines.

  5. Beyond unidirectional knowledge transfer

    DEFF Research Database (Denmark)

    Ulhøi, John Parm; Neergaard, Helle; Bjerregaard, Toke

    2012-01-01

    Using theory on technology transfer and on trust and an indepth study of nine university departments and nineteen science-based small and medium-sized enterprises (SMEs), the authors explore the nature and direction of knowledge flows during university-industry R&D collaboration. More specifically......, they examine the nature and direction of R&D technological knowledge transfer in collaborations between universities and science-based SMEs and the primary mechanisms regulating such collaborations. The findings suggest that these collaborations are highly recursive processes of technological knowledge...

  6. Energy transfer in plasmonic systems

    International Nuclear Information System (INIS)

    Pustovit, Vitaliy N; Urbas, Augustine M; Shahbazyan, Tigran V

    2014-01-01

    We present our results on energy transfer between donor and acceptor molecules or quantum dots near a plasmonic nanoparticle. In such systems, the Förster resonance energy transfer is strongly modified due to plasmon-mediated coupling between donors and acceptors. The transfer efficiency is determined by a competition between transfer, radiation and dissipation that depends sensitively on system parameters. When donor and accepror spectral bands overlap with dipole surface plasmon resonance, the dominant transfer mechanism is through plasmon-enhanced radiative coupling. When transfer takes place from an ensemble of donors to an acceptor, a cooperative amplification of energy transfer takes place in a wide range of system parameters. (paper)

  7. Heat transfer fluids containing nanoparticles

    Science.gov (United States)

    Singh, Dileep; Routbort, Jules; Routbort, A.J.; Yu, Wenhua; Timofeeva, Elena; Smith, David S.; France, David M.

    2016-05-17

    A nanofluid of a base heat transfer fluid and a plurality of ceramic nanoparticles suspended throughout the base heat transfer fluid applicable to commercial and industrial heat transfer applications. The nanofluid is stable, non-reactive and exhibits enhanced heat transfer properties relative to the base heat transfer fluid, with only minimal increases in pumping power required relative to the base heat transfer fluid. In a particular embodiment, the plurality of ceramic nanoparticles comprise silicon carbide and the base heat transfer fluid comprises water and water and ethylene glycol mixtures.

  8. Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF).

    Science.gov (United States)

    Craig, Louise E; McInnes, Elizabeth; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A; Considine, Julie; Middleton, Sandy

    2016-11-28

    Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of "environmental, context and resources" (such as stressful working conditions or lack of resources) and "knowledge" (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of "knowledge" (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and "skills" (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were "focus on past success" and "information about health consequences." Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have

  9. Office microlaparoscopic intrafallopian transfer of day one zygote ...

    African Journals Online (AJOL)

    The objective of the study was to investigate whether transferring zygotes on day 1 would result in similar pregnancy rates compared to transferring cleavage stage embryos on day 3 in a prospective randomized trial, using the office microlaparoscopic procedure. Patients undergoing IVF/ICSI treatments were randomized to ...

  10. The erotic transference: dream or delusion?

    Science.gov (United States)

    De Masi, Franco

    2012-12-01

    The erotic transference can be seen as the Janus face of clinical work in psychoanalysis: it may either arise out of the positive emotions necessary for the building of new shared realities, or be fueled by falsified and distorted constructions. In the former case, the erotic transference expresses the capacity to anticipate, or "dream," the emotional relationship with the object-which is why Freud valued its transformative aspect as one of the "forces impelling [the patient] to . . . make changes"-whereas in the latter it is equivalent to a flight from psychic reality and may be imperceptibly transformed into an actual delusion.

  11. Transfer of manufacturing units

    DEFF Research Database (Denmark)

    Madsen, Erik Skov; Riis, Jens Ove; Sørensen, Brian Vejrum

    2008-01-01

    The ongoing and unfolding relocation of activities is one of the major trends, that calls for attention in the domain of operations management. In particular, prescriptive models outlining: stages of the process, where to locate, and how to establish the new facilities have been studied, while...... and dilemmas to be addressed when transferring manufacturing units....

  12. Enhanced Condensation Heat Transfer

    Science.gov (United States)

    Rose, John Winston

    The paper gives some personal observations on various aspects of enhanced condensation heat transfer. The topics discussed are external condensation (horizontal low-finned tubes and wire-wrapped tubes), internal condensation (microfin tubes and microchannels) and Marangoni condensation of binary mixtures.

  13. Investigating Wireless Power Transfer

    Science.gov (United States)

    St. John, Stuart A.

    2017-01-01

    Understanding Physics is a great end in itself, but is also crucial to keep pace with developments in modern technology. Wireless power transfer, known to many only as a means to charge electric toothbrushes, will soon be commonplace in charging phones, electric cars and implanted medical devices. This article outlines how to produce and use a…

  14. Knowledge Management and Transfer

    Energy Technology Data Exchange (ETDEWEB)

    Sennanye, D.M.; Thugwane, S.J.; Rasweswe, M.A. [South African Young Nuclear Professionals Society, South African Nuclear Energy Cooperation, National Nuclear Regulator, P O Box 7106, Centurion 0046 (South Africa)

    2008-07-01

    Knowledge management has become an important concept in the nuclear industry globally. This has been driven by the fact that new reactors are commissioned and some are decommissioned. Since most old experts are near retirement then there is a need to capture the nuclear knowledge and expertise and transfer it to the new generation. Knowledge transfer is one of the important building blocks of knowledge management. Processes and strategies need to be developed in order to transfer this knowledge. South African Young Nuclear Professionals Society (SAYNPS) has established a document to address strategies that can be used to close the knowledge gap between the young less experienced and experts in the field. This action will help the young generation to participate in knowledge management. The major challenges will be the willingness of the experts to share and making sure that all knowledge is captured, stored and kept up to date. The paper presents the SAYNPS point of view with regard to knowledge transfer. (authors)

  15. Science transfer for development

    International Nuclear Information System (INIS)

    Salam, A.

    1985-01-01

    Despite the recent realisation that science and technology are the sustenance and major hope for economic betterment, the third world, barring a few countries like Argentina, Brazil, China and India, has taken to science - as distinct from technology - as only a marginal activity. This is also true of the aid - giving agencies of the richer countries, of the agencies of the UN and also unfortunately of the scientific communities of the developed countries which might naturally be expected to be the Third World's foremost allies. Policy makers, prestigious commissions (like the Brandt Commission) as well as aid-givers, speak uniformly of problems of technology transfer to the developing countries as if that is all that is involved. Very few within the developing world appear to stress that for long term effectiveness, technology transfers must always be accompanied by science transfers; that the science of today is the technology of tomorrow. Science transfer is effected by and to communities of scientists. Such communities (in developing countries) need building up to a critical size in their human resources and infrastructure. This building up calls for wise science policies, with long term commitment, generous patronage, self governance and free international contacts. Further, in our countries, the high level scientist must be allowed to play a role in nation building as an equal partner to the professional planner, the economist and the technologist. Few developing countries have promulgated such policies: few aid agencies have taken it as their mandate to encourage and help build up the scientific infrastructure. (author)

  16. Transfer metrics analytics project

    CERN Document Server

    Matonis, Zygimantas

    2016-01-01

    This report represents work done towards predicting transfer rates/latencies on Worldwide LHC Computing Grid (WLCG) sites using Machine Learning techniques. Topic covered are technologies used for the project, data preparation for ML suitable format and attribute selection as well as a comparison of different ML algorithms.

  17. Feed tank transfer requirements

    International Nuclear Information System (INIS)

    Freeman-Pollard, J.R.

    1998-01-01

    This document presents a definition of tank turnover; DOE responsibilities; TWRS DST permitting requirements; TWRS Authorization Basis (AB) requirements; TWRS AP Tank Farm operational requirements; unreviewed safety question (USQ) requirements; records and reporting requirements, and documentation which will require revision in support of transferring a DST in AP Tank Farm to a privatization contractor for use during Phase 1B

  18. Electron transfer to sulfides:

    International Nuclear Information System (INIS)

    Meneses, Ana Belen; Antonello, Sabrina; Arevalo, Maria Carmen; Maran, Flavio

    2005-01-01

    The problem of characterizing the steps associated with the dissociative reduction of sulfides has been addressed. The electrochemical reduction of diphenylmethyl para-methoxyphenyl sulfide in N,N-dimethylformamide, on both glassy carbon and mercury electrodes, was chosen as a test system. The electrode process involves the slow heterogeneous outer-sphere electron transfer to the sulfide, the fast cleavage of the C-S bond, the reduction of the ensuing carbon radical, and the self-protonation triggered by the generation of the strong base Ph 2 CH - . The latter reaction is rather slow, in agreement with the large intrinsic barriers characterizing proton transfers between CH-acids and carbon bases. The dissociative reduction was studied in the presence of an exogenous acid. The results, obtained by convolution analysis, point to a stepwise DET mechanism in which the ET step is accompanied by rather large reorganization energy. Similar results were obtained on both electrode materials. Analysis of the heterogeneous electron transfer and associated C-S bond cleavage indicate that the reduction of this and other sulfides lies between the stepwise dissociative electron transfers leading to the formation of stiff π* radical anions and those going through the intermediacy of loose σ* radical anions

  19. Nonadiabatic anharmonic electron transfer

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, P. P. [Molecular Physics Research, 6547 Kristina Ursula Court, Falls Church, Virginia 22044 (United States)

    2013-03-28

    The effect of an inner sphere, local mode vibration on an electron transfer is modeled using the nonadiabatic transition probability (rate) expression together with both the anharmonic Morse and the harmonic oscillator potential. For an anharmonic inner sphere mode, a variational analysis uses harmonic oscillator basis functions to overcome the difficulties evaluating Morse-model Franck-Condon overlap factors. Individual matrix elements are computed with the use of new, fast, robust, and flexible recurrence relations. The analysis therefore readily addresses changes in frequency and/or displacement of oscillator minimums in the different electron transfer states. Direct summation of the individual Boltzmann weighted Franck-Condon contributions avoids the limitations inherent in the use of the familiar high-temperature, Gaussian form of the rate constant. The effect of harmonic versus anharmonic inner sphere modes on the electron transfer is readily seen, especially in the exoergic, inverted region. The behavior of the transition probability can also be displayed as a surface for all temperatures and values of the driving force/exoergicity {Delta}=-{Delta}G. The temperature insensitivity of the transfer rate is clearly seen when the exoergicity equals the collective reorganization energy ({Delta}={Lambda}{sub s}) along a maximum ln (w) vs. {Delta} ridge of the surface. The surface also reveals additional regions for {Delta} where ln (w) appears to be insensitive to temperature, or effectively activationless, for some kinds of inner sphere contributions.

  20. Understanding Transfer of Training.

    Science.gov (United States)

    Brown, Mark G.

    1983-01-01

    Stresses the difficulty of "maintenance" of newly learned behaviors by reinforcement and feedback on the job and proposes an alternative means of promoting transfer of training--establishing rule-governed behavior. Some ways of establishing rules in training are listed and discussed, including use of behavior-modeling and other…

  1. Transfer Pricing Principles

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl

    Konferencebidraget indeholder en kritisk analyse af transfer pricing reglerne på henholdsvis moms og indkomstskatterettens område med henblik på en diskussion af, det er hensigtsmæssigt med en harmonisering af reglerne på tværs af de to retsområder...

  2. Knowledge Management and Transfer

    International Nuclear Information System (INIS)

    Sennanye, D.M.; Thugwane, S.J.; Rasweswe, M.A.

    2008-01-01

    Knowledge management has become an important concept in the nuclear industry globally. This has been driven by the fact that new reactors are commissioned and some are decommissioned. Since most old experts are near retirement then there is a need to capture the nuclear knowledge and expertise and transfer it to the new generation. Knowledge transfer is one of the important building blocks of knowledge management. Processes and strategies need to be developed in order to transfer this knowledge. South African Young Nuclear Professionals Society (SAYNPS) has established a document to address strategies that can be used to close the knowledge gap between the young less experienced and experts in the field. This action will help the young generation to participate in knowledge management. The major challenges will be the willingness of the experts to share and making sure that all knowledge is captured, stored and kept up to date. The paper presents the SAYNPS point of view with regard to knowledge transfer. (authors)

  3. Supervised Transfer Sparse Coding

    KAUST Repository

    Al-Shedivat, Maruan

    2014-07-27

    A combination of the sparse coding and transfer learn- ing techniques was shown to be accurate and robust in classification tasks where training and testing objects have a shared feature space but are sampled from differ- ent underlying distributions, i.e., belong to different do- mains. The key assumption in such case is that in spite of the domain disparity, samples from different domains share some common hidden factors. Previous methods often assumed that all the objects in the target domain are unlabeled, and thus the training set solely comprised objects from the source domain. However, in real world applications, the target domain often has some labeled objects, or one can always manually label a small num- ber of them. In this paper, we explore such possibil- ity and show how a small number of labeled data in the target domain can significantly leverage classifica- tion accuracy of the state-of-the-art transfer sparse cod- ing methods. We further propose a unified framework named supervised transfer sparse coding (STSC) which simultaneously optimizes sparse representation, domain transfer and classification. Experimental results on three applications demonstrate that a little manual labeling and then learning the model in a supervised fashion can significantly improve classification accuracy.

  4. Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality

    Directory of Open Access Journals (Sweden)

    Larentzakis Andreas

    2010-03-01

    Full Text Available Abstract Background Quality assessment of any trauma system involves the evaluation of the transferring patterns. This study aims to assess interfacility transfers in the absence of a formal trauma system setting and to estimate the benefits from implementing a more organized structure. Methods The 'Report of the Epidemiology and Management of Trauma in Greece' is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. We compared the transferred patient group to the non transferred patient group. Information reviewed included patient and injury characteristics, need for an operation, Intensive Care Unit (ICU admittance and mortality. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were then assessed according to each health care facility's availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon. Results Data on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. Transferred patients tended to be younger, male, and more severely injured than non transferred patients. Moreover, they were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non transferred patients. The 34.3% of transfers was from facilities with none of the five requirements, whereas the 12.4% was from those with one requirement. Low level facilities, with up to three requirements transferred 43.2% of their transfer volume to units of equal resources. Conclusion Trauma management in Greece results in a high number of transfers. Patients are frequently transferred between low level facilities. Better coordination could lead to improved outcomes and less cost.

  5. Type 2 diabetes mellitus is associated with differential effects on plasma cholesteryl ester transfer protein and phospholipid transfer protein activities and concentrations

    NARCIS (Netherlands)

    Dullaart, RPF; De Vries, R; Scheek, L; Borggreve, SE; Van Gent, T; Dallinga-Thie, GM; Ito, M; Nagano, M; Sluiter, WJ; Hattori, H; Van Tol, A

    Background: Human plasma contains two lipid transfer proteins, cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP), which are crucial in reverse cholesterol transport. Methods: Plasma CETP and PLTP activity levels and concentrations in 16 type 2 diabetic patients and

  6. Submandibular salivary gland transfer prevents radiation-induced xerostomia

    International Nuclear Information System (INIS)

    Jha, Naresh; Seikaly, Hadi; McGaw, Timothy; Coulter, Linda

    2000-01-01

    Background: Xerostomia is a significant morbidity of radiation therapy in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to submental space, outside the proposed radiation field, prior to starting radiation treatment, would prevent xerostomia. Methods: We are conducting a prospective clinical trial where the submandibular gland is transferred as part of the surgical intervention. The patients are followed clinically, with salivary flow studies and University of Washington quality of life questionnaire. Results: We report early results of 16 patients who have undergone this procedure. Seven patients have finished and 2 patients are currently undergoing radiation treatment. In 2 patients, no postoperative radiation treatment was indicated. Two patients are waiting to start radiation treatment and 2 patients refused treatment after surgery. The surgical transfer was abandoned in 1 patient. All of the transferred salivary glands were positioned outside the proposed radiation fields and were functional. The patients did not complain of any xerostomia and developed only minimal oral mucositis. There were no surgical complications. Conclusions: Surgical transfer of a submandibular salivary gland to the submental space (outside the radiation field) preserves its function and prevents the development of radiation-induced xerostomia

  7. Transferability between Hospitals of Hypercalcaemia Discriminant Functions

    DEFF Research Database (Denmark)

    Frølich, Anne; McNair, Peter; Nielsen, Bo Friis

    1996-01-01

    Transferability of discriminant functions is potentially useful both from an economical point of view and because, in general, medical knowledge, in this case discriminant functions, should be transferable. In the present study we have evaluated the transferability of discriminant functions......, estimated from routine laboratory analysis, age and sex in two consecutively recorded populations with hypercalcemia including 162 and 257 patients with hypercalcemia. Discriminant functions were developed for each sex to distinguish between hypercalcemia associated with malignancy and hypercalcemia...... associated with other medical diseases. The total diagnostic accuracy in Herlev was 82 and 78%, in women and men, and increased to 87 and 86% in both sexes considering cases classified with posterior probability levels of 60%. In Hvidovre the total diagnostic accuracy was 81 and 84% in women and men...

  8. [Single embryo transfer: is Scandinavian model valuable in France?].

    Science.gov (United States)

    Belaisch-Allart, J; Mayenga, J-M; Grefenstette, I; Chouraqui, A; Serkine, A-M; Abirached, F; Kulski, O

    2008-11-01

    The aim of infertility treatment is clearly to obtain one healthy baby. If the transfer of a top quality single embryo could provide a baby to all the patients, there would be no more discussion. The problem is that, nowadays, French pregnancy rates after fresh embryo or frozen embryo transfer are not the same as in Nordic countries. All studies show that in unselected patients, single embryo transfer decreases twin pregnancy rate but decreases pregnancy rate too. Pregnancy rate is dependent on embryo quality, women's age, rank of IVF attempt (clear data) but also on body mass index, ovarian reserve, smoking habits. All these data cannot be taken into account in a law. That is the reason why a flexible policy of transfer adapted to each couple is preferable. Each couple and each IVF team are unique and must keep the freedom to choose how many embryos must be transferred to obtain healthy babies, and to avoid twin pregnancies but without demonizing them.

  9. Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial.

    Science.gov (United States)

    Craig, Louise E; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A; McInnes, Elizabeth; Phillips, Rosemary; Dale, Simeon; O'Connor, Denise; Levi, Chris; Fitzgerald, Mark; Considine, Julie; Grimshaw, Jeremy M; Gerraty, Richard; Cheung, N Wah; Ward, Jeanette; Middleton, Sandy

    2017-07-17

    Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T 3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T 3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). The TDF was successfully applied in all steps of developing an implementation intervention for the T 3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research

  10. Wireless power transfer system

    Science.gov (United States)

    Wu, Hunter; Sealy, Kylee; Gilchrist, Aaron

    2016-02-23

    A system includes a first stage of an inductive power transfer system with an LCL load resonant converter with a switching section, an LCL tuning circuit, and a primary receiver pad. The IPT system includes a second stage with a secondary receiver pad, a secondary resonant circuit, a secondary rectification circuit, and a secondary decoupling converter. The secondary receiver pad connects to the secondary resonant circuit. The secondary resonant circuit connects to the secondary rectification circuit. The secondary rectification circuit connects to the secondary decoupling converter. The second stage connects to a load. The load includes an energy storage element. The second stage and load are located on a vehicle and the first stage is located at a fixed location. The primary receiver pad wirelessly transfers power to the secondary receiver pad across a gap when the vehicle positions the secondary receiver pad with respect to the primary receiver pad.

  11. Knowledge Transfers following Acquisition

    DEFF Research Database (Denmark)

    Gammelgaard, Jens

    2001-01-01

    Prior relations between the acquiring firm and the target company pave the way for knowledge transfers subsequent to the acquisitions. One major reason is that through the market-based relations the two actors build up mutual trust and simultaneously they learn how to communicate. An empirical...... study of 54 Danish acquisitions taking place abroad from 1994 to 1998 demonstrated that when there was a high level of trust between the acquiring firm and the target firm before the take-over, then medium and strong tie-binding knowledge transfer mechanisms, such as project groups and job rotation......, were used more intensively. Further, the degree of stickiness was significantly lower in the case of prior trust-based relations....

  12. CURRENT TRANSFER SYSTEMS

    Science.gov (United States)

    Watt, D.A.

    1956-07-01

    A current transfer system is described for transferring current between a rotating member and a co-axial stationary member. The particular area of application for the invention is in connection with homopolar generators where a low voltage and high current are generated. The current tramsfer system of the invention comprises a rotor member and a co-axial stator member wherein one of the members is shaped to provide a circumferential surface concave in section and the other member is shaped to have a peripheral portion in close proximity to the surface, whereby a liquid metal can be stably supported between the two members when they are moving relative to one another to establish an electrical conducting path between the members.

  13. Interidentity memory transfer in dissociative identity disorder.

    Science.gov (United States)

    Kong, Lauren L; Allen, John J B; Glisky, Elizabeth L

    2008-08-01

    Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer. Copyright (c) 2008 APA, all rights reserved.

  14. Feed tank transfer requirements

    International Nuclear Information System (INIS)

    Freeman-Pollard, J.R.

    1998-01-01

    This document presents a definition of tank turnover. Also, DOE and PC responsibilities; TWRS DST permitting requirements; TWRS Authorization Basis (AB) requirements; TWRS AP Tank Farm operational requirements; unreviewed safety question (USQ) requirements are presented for two cases (i.e., tank modifications occurring before tank turnover and tank modification occurring after tank turnover). Finally, records and reporting requirements, and documentation which will require revision in support of transferring a DST in AP Tank Farm to a privatization contractor are presented

  15. Heat Transfer Analogies

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharyya, A

    1965-11-15

    This report contains descriptions of various analogues utilised to study different steady-state and unsteady-state heat transfer problems. The analogues covered are as follows: 1 . Hydraulic: a) water flow b) air flow 2. Membrane 3. Geometric Electrical: a) Electrolytic-tank b) Conducting sheet 4. Network; a) Resistance b) R-C A comparison of the different analogues is presented in the form of a table.

  16. Heat Transfer Analogies

    International Nuclear Information System (INIS)

    Bhattacharyya, A.

    1965-11-01

    This report contains descriptions of various analogues utilised to study different steady-state and unsteady-state heat transfer problems. The analogues covered are as follows: 1 . Hydraulic: a) water flow b) air flow 2. Membrane 3. Geometric Electrical: a) Electrolytic-tank b) Conducting sheet 4. Network; a) Resistance b) R-C A comparison of the different analogues is presented in the form of a table

  17. Technology transfer for development

    International Nuclear Information System (INIS)

    Abraham, D.

    1990-07-01

    The IAEA has developed a multifaceted approach to ensure that assistance to Member States results in assured technology transfer. Through advice and planning, the IAEA helps to assess the costs and benefits of a given technology, determine the basic requirements for its efficient use in conditions specific to the country, and prepare a plan for its introduction. This report describes in brief the Technical Co-operation Programmes

  18. Heat transfer. V. 1

    International Nuclear Information System (INIS)

    1992-01-01

    This volume contains the 4 key-note lectures and 83 of the 148 papers presented at the 3rd UK National Conference on Heat Transfer. The papers are grouped under the following broad headings: boiling and condensation; heat exchangers; refrigeration and air-conditioning; natural convection; process safety and nuclear reactors; two-phase flow; post dry-out; combustion, radiation and chemical reaction. Separate abstracts have been prepared for 13 papers of relevance to nuclear reactors. (UK)

  19. Feed tank transfer requirements

    Energy Technology Data Exchange (ETDEWEB)

    Freeman-Pollard, J.R.

    1998-09-16

    This document presents a definition of tank turnover. Also, DOE and PC responsibilities; TWRS DST permitting requirements; TWRS Authorization Basis (AB) requirements; TWRS AP Tank Farm operational requirements; unreviewed safety question (USQ) requirements are presented for two cases (i.e., tank modifications occurring before tank turnover and tank modification occurring after tank turnover). Finally, records and reporting requirements, and documentation which will require revision in support of transferring a DST in AP Tank Farm to a privatization contractor are presented.

  20. Technology Transfer Report

    Science.gov (United States)

    2000-01-01

    Since its inception, Goddard has pursued a commitment to technology transfer and commercialization. For every space technology developed, Goddard strives to identify secondary applications. Goddard then provides the technologies, as well as NASA expertise and facilities, to U.S. companies, universities, and government agencies. These efforts are based in Goddard's Technology Commercialization Office. This report presents new technologies, commercialization success stories, and other Technology Commercialization Office activities in 1999.

  1. Unsupervised Typography Transfer

    OpenAIRE

    Sun, Hanfei; Luo, Yiming; Lu, Ziang

    2018-01-01

    Traditional methods in Chinese typography synthesis view characters as an assembly of radicals and strokes, but they rely on manual definition of the key points, which is still time-costing. Some recent work on computer vision proposes a brand new approach: to treat every Chinese character as an independent and inseparable image, so the pre-processing and post-processing of each character can be avoided. Then with a combination of a transfer network and a discriminating network, one typograph...

  2. Chinese Typography Transfer

    OpenAIRE

    Chang, Jie; Gu, Yujun

    2017-01-01

    In this paper, we propose a new network architecture for Chinese typography transformation based on deep learning. The architecture consists of two sub-networks: (1)a fully convolutional network(FCN) aiming at transferring specified typography style to another in condition of preserving structure information; (2)an adversarial network aiming at generating more realistic strokes in some details. Unlike models proposed before 2012 relying on the complex segmentation of Chinese components or str...

  3. Transfer closed and transfer open multimaps in minimal spaces

    International Nuclear Information System (INIS)

    Alimohammady, M.; Roohi, M.; Delavar, M.R.

    2009-01-01

    This paper is devoted to introduce the concepts of transfer closed and transfer open multimaps in minimal spaces. Also, some characterizations of them are considered. Further, the notion of minimal local intersection property will be introduced and characterized. Moreover, some maximal element theorems via minimal transfer closed multimaps and minimal local intersection property are given.

  4. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

    Science.gov (United States)

    Ho, Bryant; Khan, Zubair; Switaj, Paul J; Ochenjele, George; Fuchs, Daniel; Dahl, William; Cederna, Paul; Kung, Theodore A; Kadakia, Anish R

    2014-08-06

    Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer. We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer. Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength. The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

  5. Heavy ion transfer reactions

    International Nuclear Information System (INIS)

    Weisser, D.C.

    1977-06-01

    To complement discussions on the role of γ rays in heavy ion induced reactions, the author discusses the role played by particle detection. Transfer reactions are part of this subject and are among those in which one infers the properties of the residual nucleus in a reaction by observing the emerging light nucleus. Inelastic scattering ought not be excluded from this subject, although no particles are transferred, because of the role it plays in multistep reactions and in fixing O.M. parameters describing the entrance channel of the reaction. Heavy ion transfer reaction studies have been under study for some years and yet this research is still in its infancy. The experimental techniques are difficult and the demands on theory rigorous. One of the main products of heavy ion research has been the thrust to re-examine the assumptions of reaction theory and now include many effects neglected for light ion analysis. This research has spurred the addition of multistep processes to simple direct processes and coupled channel calculations. (J.R.)

  6. Ecological transfer mechanisms - Terrestrial

    International Nuclear Information System (INIS)

    Martin, W.E.; Raines, Gilbert E.; Bloom, S.G.; Levin, A.A.

    1969-01-01

    Radionuclides produced by nuclear excavation detonations and released to the environment may enter a variety of biogeochemical cycles and follow essentially the same transfer pathways as their stable-element counterparts. Estimation of potential internal radiation doses to individuals and/or populations living in or near fallout-contaminated areas requires analysis of the food-chain and other ecological pathways by which radionuclides released to the environment may be returned to man. A generalized materials transfer diagram, applicable to the forest, agricultural, freshwater and marine ecosystems providing food and water to the indigenous population of Panama and Colombia in regions that could be affected by nuclear excavation of a sea-level canal between the Atlantic and Pacific Oceans, is presented. Transfer mechanisms effecting the movement of stable elements and radionuclides in terrestrial ecosystems are discussed, and methods used to simulate these processes by means of mathematical models are described to show how intake values are calculated for different radionuclides in the major ecological pathways leading to man. These data provide a basis for estimating potential internal radiation doses for comparison with the radiation protection criteria established by recognized authorities; and this, in turn, provides a basis for recommending measures to insure the radiological safety of the nuclear operation plan. (author)

  7. Ecological transfer mechanisms - Terrestrial

    Energy Technology Data Exchange (ETDEWEB)

    Martin, W E; Raines, Gilbert E; Bloom, S G; Levin, A A [Battelle Memorial Institute, CoIumbus, OH (United States)

    1969-07-01

    Radionuclides produced by nuclear excavation detonations and released to the environment may enter a variety of biogeochemical cycles and follow essentially the same transfer pathways as their stable-element counterparts. Estimation of potential internal radiation doses to individuals and/or populations living in or near fallout-contaminated areas requires analysis of the food-chain and other ecological pathways by which radionuclides released to the environment may be returned to man. A generalized materials transfer diagram, applicable to the forest, agricultural, freshwater and marine ecosystems providing food and water to the indigenous population of Panama and Colombia in regions that could be affected by nuclear excavation of a sea-level canal between the Atlantic and Pacific Oceans, is presented. Transfer mechanisms effecting the movement of stable elements and radionuclides in terrestrial ecosystems are discussed, and methods used to simulate these processes by means of mathematical models are described to show how intake values are calculated for different radionuclides in the major ecological pathways leading to man. These data provide a basis for estimating potential internal radiation doses for comparison with the radiation protection criteria established by recognized authorities; and this, in turn, provides a basis for recommending measures to insure the radiological safety of the nuclear operation plan. (author)

  8. Nucleate boiling heat transfer

    Energy Technology Data Exchange (ETDEWEB)

    Saiz Jabardo, J.M. [Universidade da Coruna (Spain). Escola Politecnica Superior], e-mail: mjabardo@cdf.udc.es

    2009-07-01

    Nucleate boiling heat transfer has been intensely studied during the last 70 years. However boiling remains a science to be understood and equated. In other words, using the definition given by Boulding, it is an 'insecure science'. It would be pretentious of the part of the author to explore all the nuances that the title of the paper suggests in a single conference paper. Instead the paper will focus on one interesting aspect such as the effect of the surface microstructure on nucleate boiling heat transfer. A summary of a chronological literature survey is done followed by an analysis of the results of an experimental investigation of boiling on tubes of different materials and surface roughness. The effect of the surface roughness is performed through data from the boiling of refrigerants R-134a and R-123, medium and low pressure refrigerants, respectively. In order to investigate the extent to which the surface roughness affects boiling heat transfer, very rough surfaces (4.6 {mu}m and 10.5 {mu}m ) have been tested. Though most of the data confirm previous literature trends, the very rough surfaces present a peculiar behaviour with respect to that of the smoother surfaces (Ra<3.0 {mu}m). (author)

  9. Laser induced energy transfer

    International Nuclear Information System (INIS)

    Falcone, R.W.

    1979-01-01

    Two related methods of rapidly transferring stored energy from one excited chemical species to another are described. The first of these, called a laser induced collision, involves a reaction in which the energy balance is met by photons from an intense laser beam. A collision cross section of ca 10 - 17 cm 2 was induced in an experiment which demonstrated the predicted dependence of the cross section on wavelength and power density of the applied laser. A second type of laser induced energy transfer involves the inelastic scattering of laser radiation from energetically excited atoms, and subsequent absorption of the scattered light by a second species. The technique of producing the light, ''anti-Stokes Raman'' scattering of visible and infrared wavelength laser photons, is shown to be an efficient source of narrow bandwidth, high brightness, tunable radiation at vacuum ultraviolet wavelengths by using it to excite a rare gas transition at 583.7 A. In addition, this light source was used to make the first measurement of the isotopic shift of the helium metastable level at 601 A. Applications in laser controlled chemistry and spectroscopy, and proposals for new types of lasers using these two energy transfer methods are discussed

  10. Nucleate boiling heat transfer

    International Nuclear Information System (INIS)

    Saiz Jabardo, J.M.

    2009-01-01

    Nucleate boiling heat transfer has been intensely studied during the last 70 years. However boiling remains a science to be understood and equated. In other words, using the definition given by Boulding, it is an 'insecure science'. It would be pretentious of the part of the author to explore all the nuances that the title of the paper suggests in a single conference paper. Instead the paper will focus on one interesting aspect such as the effect of the surface microstructure on nucleate boiling heat transfer. A summary of a chronological literature survey is done followed by an analysis of the results of an experimental investigation of boiling on tubes of different materials and surface roughness. The effect of the surface roughness is performed through data from the boiling of refrigerants R-134a and R-123, medium and low pressure refrigerants, respectively. In order to investigate the extent to which the surface roughness affects boiling heat transfer, very rough surfaces (4.6 μm and 10.5 μm ) have been tested. Though most of the data confirm previous literature trends, the very rough surfaces present a peculiar behaviour with respect to that of the smoother surfaces (Ra<3.0 μm). (author)

  11. Deep Transfer Metric Learning.

    Science.gov (United States)

    Junlin Hu; Jiwen Lu; Yap-Peng Tan; Jie Zhou

    2016-12-01

    Conventional metric learning methods usually assume that the training and test samples are captured in similar scenarios so that their distributions are assumed to be the same. This assumption does not hold in many real visual recognition applications, especially when samples are captured across different data sets. In this paper, we propose a new deep transfer metric learning (DTML) method to learn a set of hierarchical nonlinear transformations for cross-domain visual recognition by transferring discriminative knowledge from the labeled source domain to the unlabeled target domain. Specifically, our DTML learns a deep metric network by maximizing the inter-class variations and minimizing the intra-class variations, and minimizing the distribution divergence between the source domain and the target domain at the top layer of the network. To better exploit the discriminative information from the source domain, we further develop a deeply supervised transfer metric learning (DSTML) method by including an additional objective on DTML, where the output of both the hidden layers and the top layer are optimized jointly. To preserve the local manifold of input data points in the metric space, we present two new methods, DTML with autoencoder regularization and DSTML with autoencoder regularization. Experimental results on face verification, person re-identification, and handwritten digit recognition validate the effectiveness of the proposed methods.

  12. Californium source transfer

    International Nuclear Information System (INIS)

    Wallace, C.R.

    1995-01-01

    In early 1995, the receipt of four sealed californium-252 sources from Oak Ridge National Lab was successfully accomplished by a team comprised of Radiological Engineering, Radiological Operations and Health Physics Instrumentation personnel. A procedure was developed and walked-down by the participants during a Dry Run Evolution. Several special tools were developed during the pre-planning phases of the project which reduced individual and job dose to minimal levels. These included a mobile lifting device for attachment of a transfer ball valve assembly to the undercarriage of the Cannonball Carrier, a transfer tube elbow to ensure proper angle of the source transfer tube, and several tools used during emergency response for remote retrieval and handling of an unshielded source. Lessons were learned in the areas of contamination control, emergency preparedness, and benefits of thorough pre-planning, effectiveness of locally creating and designing special tools to reduce worker dose, and methods of successfully accomplishing source receipt evolutions during extreme or inclement weather

  13. What Is Technology Transfer? | Poster

    Science.gov (United States)

    The NCI Technology Transfer Center (TTC) facilitates partnerships between NIH research laboratories and external partners. With a team of technology transfer specialists, NCI TTC guides interactions from discovery to patenting, as well as from collaboration and invention development to licensing.

  14. Technology transfer of Cornell university

    International Nuclear Information System (INIS)

    Yoo, Wan Sik

    2010-01-01

    This book introduces technology transfer of Cornell university which deals with introduction of Cornell university, composition of organization and practice of technology transfer : a research contract, research perform, invention report, evaluation and succession of invention, a patent application and management, marketing, negotiation and writing contract, management of contract, compensation, result of technology transfer, cases of success on technical commercialization and daily life of technology transfer center.

  15. Design of LEIR Transfer Lines

    CERN Document Server

    Carli, Ch; Hemery, J-Y

    2002-01-01

    The LEIR transfer lines are designed to transport the ion beam from the Linac 3 to LEIR and, after accumulation and acceleration from LEIR to the PS. A part of the transfer line is used for both, injection and extraction. Thus, it is natural to design injection and extraction optics in common. Beside optics constraints, the geometry of the existing machines (Linac 3, LEIR and PS) and transfer tunnels have to be respected. A new proposal for the LEIR transfer lines is presented.

  16. Technology transfer in CANDU marketing

    International Nuclear Information System (INIS)

    Pon, G.A.

    1982-06-01

    The author discusses how the CANDU system lends itself to technology transfer, the scope of CANDU technology transfer, and the benefits and problems associated with technology transfer. The establishment of joint ventures between supplier and client nations offers benefits to both parties. Canada can offer varying technology transfer packages, each tailored to a client nation's needs and capabilities. Such a package could include all the hardware and software necessary to develop a self-sufficient nuclear infrastructure in the client nation

  17. Energy transfer properties and mechanisms

    International Nuclear Information System (INIS)

    1991-01-01

    This report discusses the energy transfer mechanisms in azulene, benzene, toluene, and isotopomers. Also discussed is the coupled energy reservoirs model, quantum effects in energy transfer, NO 2 energy transfer, densities of states, the reactant states model, and O 3 excited electronic states

  18. Evaluating Technology Transfer and Diffusion.

    Science.gov (United States)

    Bozeman, Barry; And Others

    1988-01-01

    Four articles discuss the evaluation of technology transfer and diffusion: (1) "Technology Transfer at the U.S. National Laboratories: A Framework for Evaluation"; (2) "Application of Social Psychological and Evaluation Research: Lessons from Energy Information Programs"; (3) "Technology and Knowledge Transfer in Energy R and D Laboratories: An…

  19. Does a frozen embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles?

    Science.gov (United States)

    Healy, Mae Wu; Patounakis, George; Connell, Matt T; Devine, Kate; DeCherney, Alan H; Levy, Michael J; Hill, Micah J

    2016-01-01

    To compare the effect of progesterone (P) on the day of trigger in fresh assisted reproduction technology (ART) transfer cycles versus its effect on subsequent frozen embryo transfer (FET) cycles. Retrospective cohort study. Large private ART practice. Fresh autologous and FET cycles from 2011-2013. None. Live birth. A paired analysis of patients who underwent both a fresh transfer and subsequent FET cycle and an unpaired analysis of data from all fresh transfer cycles and all FET cycles were performed. We analyzed 1,216 paired and 4,124 unpaired cycles, and P was negatively associated with birth in fresh but not FET cycles in all analyses. Interaction testing of P and cycle type indicated P had a different association with birth in fresh versus FET cycles. When P was ≥ 2 ng/mL at the time of trigger, live birth was more likely in FET versus fresh cycles in the paired analysis (47% vs. 10%), in the unpaired analysis (51% vs. 14%), and in unpaired, good blastocyst only transfer subgroup (51% vs. 29%). Live birth was similar in FET cycles, with P ≥ 2 ng/mL versus P cycles, with P ≥ 2 ng/mL versus P cycle were negatively associated with live birth in the fresh transfer cycles but not in subsequent FET cycles. Freezing embryos and performing a subsequent FET cycle ameliorates the effect of elevated P on live-birth rates. Published by Elsevier Inc.

  20. Resource Transfers to the Elderly: Do Adult Children Substitute Financial Transfers for Time Transfers

    National Research Council Canada - National Science Library

    Zissimopoulos, Julie

    2001-01-01

    Using the Health and Retirement Study, this research investigates whether an adult child substitutes financial transfers to an elderly parent for time transfers as the cost of his or her time increases...

  1. TRIUMF: Technology transfer

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    In our occasional series highlighting the increasingly important area of technology transfer and industrial spinoff from high energy physics, this month the CERN Courier focuses on TRIUMF in Vancouver, Canada's major national facility for research in subatomic physics, a particularly illustrative example of the rewards and challenges involved. TRIUMF is based on a 520 MeV negative hydrogen ion cyclotron meson factory operated by a consortium of Canadian universities. Although the primary funding from the Canadian government is earmarked for support of basic research, the laboratory has always fostered applications of the technologies available, supporting them with funds from other sources. At first this ''applied programme'' involved simply the provision of particle beams for other scientific, medical and industrial uses - protons for the development of neutrondeficient radioisotopes, neutrons for activation analysis, pions for cancer therapy, and muons for chemistry and condensed-matter physics. Twenty five years on, the technology transfer process has resulted not only in a significantly expanded internal applied programme, with many areas of activity quite independent of the big cyclotron, but also in a number of successful commercial operations in the Vancouver area. Radioisotope production has been a particularly fruitful source for technology transfer, the early development work leading to two important initiatives - the establishment of a commercial radioisotope production facility on site and the inauguration of a positron emission tomography (PET) program at the University of British Columbia nearby. In 1979 Atomic Energy of Canada Ltd's isotope production division (now Nordion International Inc.) decided to establish a western Canadian facility at TRIUMF, to produce the increasingly important neutron-deficient radioisotopes obtainable with accelerator beams, primarily for medical applications. This would complement their

  2. Enabling cleanup technology transfer

    International Nuclear Information System (INIS)

    Ditmars, J. D.

    2002-01-01

    Technology transfer in the environmental restoration, or cleanup, area has been challenging. While there is little doubt that innovative technologies are needed to reduce the times, risks, and costs associated with the cleanup of federal sites, particularly those of the Departments of Energy (DOE) and Defense, the use of such technologies in actual cleanups has been relatively limited. There are, of course, many reasons why technologies do not reach the implementation phase or do not get transferred from developing entities to the user community. For example, many past cleanup contracts provided few incentives for performance that would compel a contractor to seek improvement via technology applications. While performance-based contracts are becoming more common, they alone will not drive increased technology applications. This paper focuses on some applications of cleanup methodologies and technologies that have been successful and are illustrative of a more general principle. The principle is at once obvious and not widely practiced. It is that, with few exceptions, innovative cleanup technologies are rarely implemented successfully alone but rather are implemented in the context of enabling processes and methodologies. And, since cleanup is conducted in a regulatory environment, the stage is better set for technology transfer when the context includes substantive interactions with the relevant stakeholders. Examples of this principle are drawn from Argonne National Laboratory's experiences in Adaptive Sampling and Analysis Programs (ASAPs), Precise Excavation, and the DOE Technology Connection (TechCon) Program. The lessons learned may be applicable to the continuing challenges posed by the cleanup and long-term stewardship of radioactive contaminants and unexploded ordnance (UXO) at federal sites

  3. Transference to the analyst as an excluded observer.

    Science.gov (United States)

    Steiner, John

    2008-02-01

    In this paper I briefly review some significant points in the development of ideas on transference which owe so much to the discoveries of Freud. I then discuss some of the subsequent developments which were based on Freud 's work and which have personally impressed me. In particular I mention Melanie Klein's elaboration of an internal world peopled by internal object and her description of the mechanisms of splitting and projective identification, both of which profoundly affect our understanding of transference. Using some clinical material I try to illustrate an important transference situation which I do not think has been sufficiently emphasized although it is part of the 'total situation' outlined by Klein. In this kind of transference the analyst finds himself in an observing position and is no longer the primary object to whom love and hate are directed. Instead he is put in a position of an excluded figure who can easily enact rather than understand the role he has been put in. In this situation he may try to regain the position as the patient's primary object in the transference or avoid the transference altogether and make extra-transference interpretations and in this way enact the role of a judgemental and critical super-ego. If he can tolerate the loss of a central role and understand the transference position he has been put in, the analyst can sometimes reduce enactments and release feelings to do with mourning and loss in both himself and his patient.

  4. Magnetic resonance imaging findings after rectus femoris transfer surgery

    International Nuclear Information System (INIS)

    Gold, Garry E.; Asakawa, Deanna S.; Blemker, Silvia S.; Delp, Scott L.

    2004-01-01

    We describe the magnetic resonance (MR) imaging appearance of the knee flexor and extensor tendons after bilateral rectus femoris transfer and hamstring lengthening surgery in five patients (10 limbs) with cerebral palsy. Three-dimensional models of the path of the transferred tendon were constructed in all cases. MR images of the transferred and lengthened tendons were examined and compared with images from ten non-surgical subjects. The models showed that the path of the transferred rectus femoris tendon had a marked angular deviation near the transfer site in all cases. MR imaging demonstrated irregular areas of low signal intensity near the transferred rectus femoris and around the hamstrings in all subjects. Eight of the ten post-surgical limbs showed evidence of fluid near or around the transferred or lengthened tendons. This was not observed in the non-surgical subjects. Thus, MR imaging of patients with cerebral palsy after rectus femoris transfer and hamstring-lengthening surgery shows evidence of signal intensity and contour changes, even several years after surgery. (orig.)

  5. Measuring of heat transfer coefficient

    DEFF Research Database (Denmark)

    Henningsen, Poul; Lindegren, Maria

    Subtask 3.4 Measuring of heat transfer coefficient Subtask 3.4.1 Design and setting up of tests to measure heat transfer coefficient Objective: Complementary testing methods together with the relevant experimental equipment are to be designed by the two partners involved in order to measure...... the heat transfer coefficient for a wide range of interface conditions in hot and warm forging processes. Subtask 3.4.2 Measurement of heat transfer coefficient The objective of subtask 3.4.2 is to determine heat transfer values for different interface conditions reflecting those typically operating in hot...

  6. Advances in electron transfer chemistry

    CERN Document Server

    Mariano, Patrick S

    1993-01-01

    Advances in Electron Transfer Chemistry, Volume 3 presents studies that discuss findings in the various aspects of electron chemistry. The book is comprised of four chapters; each chapter reviews a work that tackles an issue in electron transfer chemistry. Chapter 1 discusses the photoinduced electron transfer in flexible biaryl donor-acceptor molecules. Chapter 2 tackles light-induced electron transfer in inorganic systems in homogeneous and heterogeneous phases. The book also covers internal geometry relaxation effects on electron transfer rates of amino-centered systems. The sequential elec

  7. Matching with transfer matrices

    International Nuclear Information System (INIS)

    Perez-Alvarez, R.; Velasco, V.R.; Garcia-Moliner, F.; Rodriguez-Coppola, H.

    1987-10-01

    An ABC configuration - which corresponds to various systems of physical interest, such as a barrier or a quantum well - is studied by combining a surface Green function matching analysis of the entire system with a description of the intermediate (B) region in terms of a transfer matrix in the sense of Mora et al. (1985). This hybrid approach proves very useful when it is very difficult to construct the corresponding Green function G B . An application is made to the calculation of quantised subband levels in a parabolic quantum well. Further possibilities of extension of this approach are pointed out. (author). 27 refs, 1 tab

  8. Investigating wireless power transfer

    Science.gov (United States)

    St John, Stuart A.

    2017-09-01

    Understanding Physics is a great end in itself, but is also crucial to keep pace with developments in modern technology. Wireless power transfer, known to many only as a means to charge electric toothbrushes, will soon be commonplace in charging phones, electric cars and implanted medical devices. This article outlines how to produce and use a simple set of equipment to both demonstrate and investigate this phenomenon. It presents some initial findings and aims to encourage Physics educators and their students to conduct further research, pushing the bounds of their understanding.

  9. Technology transfer and innovation

    International Nuclear Information System (INIS)

    Ashworth, Graham; Thornton, Anna

    1987-01-01

    The aims of the conference were advice, assistance and action for all those with technology to licence or inventions to patent, and for people seeking financial help and advice. There was a free exchange of ideas and information. Of the forty or so papers collected together, many are concerned with the financial aspects of new ventures, others look at technology transfer from academic institutes and schemes which support technological problems. One paper on fast reactor collaboration in Europe, is indexed separately. (U.K.)

  10. Introduction to heat transfer

    International Nuclear Information System (INIS)

    Weisman, J.

    1983-01-01

    Heat may be defined as that form of energy which spontaneously flows between two bodies, or two regions of a body, by virtue of a temperature difference. The second law of thermodynamics tells us that we cannot have heat flow from a low temperature to high temperature without doing work. Heat flows spontaneously from a high temperature to a low temperature region. Thermodynamics, which is concerned with equilibrium states, cannot tell us anything about the rate of heat flow in the presence of a finite temperature difference. It is to the discipline of heat transfer to which we must turn for this answer

  11. Magnetization transfer MR of cerebrovascular disorders using calculated images

    Energy Technology Data Exchange (ETDEWEB)

    Enomoto, Kyoko; Watabe, Tsuneya; Amanuma, Makoto; Heshiki, Atsuko [Saitama Medical School, Moroyama, Saitama (Japan)

    1997-06-01

    This study applied a magnetization transfer contrast method to patients with cerebrovascular disorders. A 1.5 T superconducting MR unit was used, and magnetization transfer ratio (MTR) images were calculated by evaluating two paired images before and after off-resonance gradient echo pulse sequences. The normal white matter showed the highest MTRs, CSF the lowest, and gray matter, intermediate. Cerebral ischemic patients showed two patterns according to the chronological stage of the affected area. Lesions in the acute and subacute stages revealed higher transfer rates than those in the chronic stage. Patients with cerebral hemorrhage were divided into three groups: the hyperacute group showed a low transfer pattern; the acute group presented inhomogeneous high transfer rates; and the subacute group showed remarkably low transfer rates. In the acute and subacute ischemic stages, increased macromolecules caused higher MTRs than in the chronic stage. In hemorrhagic groups, low MTRs in subacute hemorrhage reflected the transfer of methemoglobin. High MTRs in acute hemorrhage with rich deoxyhemoglobin suggested increased fibrin, plasma, and serum components of macromolecules. The MTC method provided new chronological information on cerebral hemorrhage, adding to that provided by routine MR images. (author)

  12. Transfer Learning beyond Text Classification

    Science.gov (United States)

    Yang, Qiang

    Transfer learning is a new machine learning and data mining framework that allows the training and test data to come from different distributions or feature spaces. We can find many novel applications of machine learning and data mining where transfer learning is necessary. While much has been done in transfer learning in text classification and reinforcement learning, there has been a lack of documented success stories of novel applications of transfer learning in other areas. In this invited article, I will argue that transfer learning is in fact quite ubiquitous in many real world applications. In this article, I will illustrate this point through an overview of a broad spectrum of applications of transfer learning that range from collaborative filtering to sensor based location estimation and logical action model learning for AI planning. I will also discuss some potential future directions of transfer learning.

  13. [Transference in the treatment of dissociative identity disorder: A review of literature and a case example].

    Science.gov (United States)

    Lambert, Ann Marie; Gagnon, Lise; Fontaine, Francine S

    2014-01-01

    A literature review about transference in the treatment of dissociative identity disorder (DID) is presented. Common transference reactions resulting from serious traumas are explored, considering that those kind of trauma are higly present in the pathways of DID patients. Post traumatic transference aspects specific to DID are also presented. In addition, common transference patterns and dissociative aspects of transference in the treatment of DID are explained. Transference is also discussed in relationship to the possible impact of disorganized attachment, which is a main component in the development of DID. The clinical implications of this proposition will be discussed and supported by a case example.

  14. Dams and Intergovernmental Transfers

    Science.gov (United States)

    Bao, X.

    2012-12-01

    Gainers and Losers are always associated with large scale hydrological infrastructure construction, such as dams, canals and water treatment facilities. Since most of these projects are public services and public goods, Some of these uneven impacts cannot fully be solved by markets. This paper tried to explore whether the governments are paying any effort to balance the uneven distributional impacts caused by dam construction or not. It showed that dam construction brought an average 2% decrease in per capita tax revenue in the upstream counties, a 30% increase in the dam-location counties and an insignificant increase in downstream counties. Similar distributional impacts were observed for other outcome variables. like rural income and agricultural crop yields, though the impacts differ across different crops. The paper also found some balancing efforts from inter-governmental transfers to reduce the unevenly distributed impacts caused by dam construction. However, overall the inter-governmental fiscal transfer efforts were not large enough to fully correct those uneven distributions, reflected from a 2% decrease of per capita GDP in upstream counties and increase of per capita GDP in local and downstream counties. This paper may shed some lights on the governmental considerations in the decision making process for large hydrological infrastructures.

  15. International nuclear technology transfer

    International Nuclear Information System (INIS)

    Cartwright, P.; Rocchio, J.P.

    1978-01-01

    Light water reactors (LWRs), originally developed in the United States, became the nuclear workhorses for utilities in Europe and Japan largely because the U.S. industry was willing and able to transfer its nuclear know-how abroad. In this international effort, the industry had the encouragement and support of the U.S. governement. In the case of the boiling water reactor (BWR) the program for technology transfer was developed in response to overseas customer demands for support in building local designs and manufacturing capabilities. The principal vehicles have been technology exchange agreements through which complete engineering and manufacturing information is furnished covering BWR systems and fuel. Agreements are held with companies in Germany, Japan, Italy, and Sweden. In recent years, a comprehensive program of joint technology development with overseas manufacturers has begun. The rapidly escalating cost of nuclear research and development make it desirable to minimize duplication of effort. These joint programs provide a mechanism for two or more parties jointly to plan a development program, assign work tasks among themselves, and exchange test results. Despite a slower-than-hoped-for start, nuclear power today is playing a significant role in the economic growth of some developing countries, and can continue to do so. Roughly half of the 23 free world nations that have adopted LWRs are developing countries

  16. aerodynamics and heat transfer

    Directory of Open Access Journals (Sweden)

    J. N. Rajadas

    1998-01-01

    Full Text Available A multidisciplinary optimization procedure, with the integration of aerodynamic and heat transfer criteria, has been developed for the design of gas turbine blades. Two different optimization formulations have been used. In the first formulation, the maximum temperature in the blade section is chosen as the objective function to be minimized. An upper bound constraint is imposed on the blade average temperature and a lower bound constraint is imposed on the blade tangential force coefficient. In the second formulation, the blade average and maximum temperatures are chosen as objective functions. In both formulations, bounds are imposed on the velocity gradients at several points along the surface of the airfoil to eliminate leading edge velocity spikes which deteriorate aerodynamic performance. Shape optimization is performed using the blade external and coolant path geometric parameters as design variables. Aerodynamic analysis is performed using a panel code. Heat transfer analysis is performed using the finite element method. A gradient based procedure in conjunction with an approximate analysis technique is used for optimization. The results obtained using both optimization techniques are compared with a reference geometry. Both techniques yield significant improvements with the multiobjective formulation resulting in slightly superior design.

  17. Technology transfer at TRIUMF

    International Nuclear Information System (INIS)

    Gardner, P.

    1994-06-01

    TRIUMF is Canada's major national research centre for sub-atomic physics. For the past five or six years, there has been an increasing emphasis on commercializing the technology that has emanated from the scientific research at the facility. This emphasis on technology transfer reflects a national policy trend of the Canadian federal government, which is the funding source for the majority of the research performed at TRIUMF. In TRIUMF's case, however, the initiative and funding for the commercialization office came from the provincial, or local government. This paper will describe the evolution of technology transfer at the TRIUMF facility, identifying the theory, policies and practical procedures that have been developed and followed. It will also include TRIUMF's experiences in finding exploitable technologies, protecting those technologies, and locating and linking with suitable industry partners to commercialize the technologies. There will be a discussion of resource allocation, and how TRIUMF has endeavoured to establish a portfolio of projects of assorted risks and expected returns. (author). 15 refs

  18. High performance data transfer

    Science.gov (United States)

    Cottrell, R.; Fang, C.; Hanushevsky, A.; Kreuger, W.; Yang, W.

    2017-10-01

    The exponentially increasing need for high speed data transfer is driven by big data, and cloud computing together with the needs of data intensive science, High Performance Computing (HPC), defense, the oil and gas industry etc. We report on the Zettar ZX software. This has been developed since 2013 to meet these growing needs by providing high performance data transfer and encryption in a scalable, balanced, easy to deploy and use way while minimizing power and space utilization. In collaboration with several commercial vendors, Proofs of Concept (PoC) consisting of clusters have been put together using off-the- shelf components to test the ZX scalability and ability to balance services using multiple cores, and links. The PoCs are based on SSD flash storage that is managed by a parallel file system. Each cluster occupies 4 rack units. Using the PoCs, between clusters we have achieved almost 200Gbps memory to memory over two 100Gbps links, and 70Gbps parallel file to parallel file with encryption over a 5000 mile 100Gbps link.

  19. Local Transfer Coefficient, Smooth Channel

    Directory of Open Access Journals (Sweden)

    R. T. Kukreja

    1998-01-01

    Full Text Available Naphthalene sublimation technique and the heat/mass transfer analogy are used to determine the detailed local heat/mass transfer distributions on the leading and trailing walls of a twopass square channel with smooth walls that rotates about a perpendicular axis. Since the variation of density is small in the flow through the channel, buoyancy effect is negligible. Results show that, in both the stationary and rotating channel cases, very large spanwise variations of the mass transfer exist in he turn and in the region immediately downstream of the turn in the second straight pass. In the first straight pass, the rotation-induced Coriolis forces reduce the mass transfer on the leading wall and increase the mass transfer on the trailing wall. In the turn, rotation significantly increases the mass transfer on the leading wall, especially in the upstream half of the turn. Rotation also increases the mass transfer on the trailing wall, more in the downstream half of the turn than in the upstream half of the turn. Immediately downstream of the turn, rotation causes the mass transfer to be much higher on the trailing wall near the downstream corner of the tip of the inner wall than on the opposite leading wall. The mass transfer in the second pass is higher on the leading wall than on the trailing wall. A slower flow causes higher mass transfer enhancement in the turn on both the leading and trailing walls.

  20. Surgical outcomes following nerve transfers in upper brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Bhandari P

    2009-01-01

    Full Text Available Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations, surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients, and phrenic nerve to suprascapular nerve (1 patient. In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients, intercostal nerves (2 patients, and phrenic nerve with nerve graft (2 patients. Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients, both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients, spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient, intercostal nerves (3rd, 4th and 5th to musculocutaneous nerve (4 patients and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient. Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170

  1. The threat of male-to-female erotic transference.

    Science.gov (United States)

    Celenza, Andrea

    2006-01-01

    Vignettes from an ongoing psychoanalysis with a patient, Michael, are presented to illustrate the various dimensions of the erotic transference at different phases of the treatment. The relation to power, the experience and expression of aggression, how these may be organized by gender, and the female analyst's countertransference are discussed as potentially fostering or inhibitory in the development of an erotic transference. Traditional sociocultural gender stereotypes kept alive in fantasy can cause female analysts to subtly foreclose the impending threat of an intense erotic transference with male analysands due to a fear of outwardly directed male aggression. It is suggested that the maternal/containing transference can be unconsciously fostered by both analyst and analysand to defensively avoid expression of the aggressivized erotic transference in its full intensity. Similarities and differences in cases of sexual boundary violations with opposite-gender pairings are discussed.

  2. Simulation analysis on miniature wireless power transfer system

    Science.gov (United States)

    Liu, Tao; Wei, Zhiqiang; Yin, Bo; Chi, Haokun; Du, Panpan

    2018-03-01

    In recent years, the research on implantable medical devices has become a hot scientific topic, and the power supply of these devices are especially concerned. Generally, these devices are usually powered by disposable batteries. However, for some of the long-term human implant devices, such as pacemakers, once the battery has been exhausted after several years, the patient has to replace the battery by surgery, which increases the patient’s economic burden and pain. Wireless power transfer technology, using non-contact way for power transfer, can be a good solution to this problem. In this paper, a micro induction coil was designed, and the transfer efficiency in the air and human tissue model of two-layers were simulated by Ansoft HFSS. The results showed that the system could achieve the energy transfer in both cases, meanwhile, it indicated that the transfer efficiency was lower in a relative larger permittivity of transmission medium.

  3. Transfer-of-Care Communication: Nursing Best Practices.

    Science.gov (United States)

    Chard, Robin; Makary, Martin A

    2015-10-01

    The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient's needs and goals--information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  4. Heat transfer physics

    CERN Document Server

    Kaviany, Massoud

    2014-01-01

    This graduate textbook describes atomic-level kinetics (mechanisms and rates) of thermal energy storage, transport (conduction, convection, and radiation), and transformation (various energy conversions) by principal energy carriers. The approach combines the fundamentals of molecular orbitals-potentials, statistical thermodynamics, computational molecular dynamics, quantum energy states, transport theories, solid-state and fluid-state physics, and quantum optics. The textbook presents a unified theory, over fine-structure/molecular-dynamics/Boltzmann/macroscopic length and time scales, of heat transfer kinetics in terms of transition rates and relaxation times, and its modern applications, including nano- and microscale size effects. Numerous examples, illustrations, and homework problems with answers that enhance learning are included. This new edition includes applications in energy conversion (including chemical bond, nuclear, and solar), expanded examples of size effects, inclusion of junction quantum tr...

  5. HEAT TRANSFER METHOD

    Science.gov (United States)

    Gambill, W.R.; Greene, N.D.

    1960-08-30

    A method is given for increasing burn-out heat fluxes under nucleate boiling conditions in heat exchanger tubes without incurring an increase in pumping power requirements. This increase is achieved by utilizing a spinning flow having a rotational velocity sufficient to produce a centrifugal acceleration of at least 10,000 g at the tube wall. At this acceleration the heat-transfer rate at burn out is nearly twice the rate which can be achieved in a similar tube utilizing axial flow at the same pumping power. At higher accelerations the improvement over axial flow is greater, and heat fluxes in excess of 50 x 10/sup 6/ Btu/hr/sq ft can be achieved.

  6. Heat transfer probe

    Science.gov (United States)

    Frank, Jeffrey I.; Rosengart, Axel J.; Kasza, Ken; Yu, Wenhua; Chien, Tai-Hsin; Franklin, Jeff

    2006-10-10

    Apparatuses, systems, methods, and computer code for, among other things, monitoring the health of samples such as the brain while providing local cooling or heating. A representative device is a heat transfer probe, which includes an inner channel, a tip, a concentric outer channel, a first temperature sensor, and a second temperature sensor. The inner channel is configured to transport working fluid from an inner inlet to an inner outlet. The tip is configured to receive at least a portion of the working fluid from the inner outlet. The concentric outer channel is configured to transport the working fluid from the inner outlet to an outer outlet. The first temperature sensor is coupled to the tip, and the second temperature sensor spaced apart from the first temperature sensor.

  7. Managerial technology transfer

    CERN Document Server

    2012-01-01

    Organisations need to think globally, but act locally - with a full appreciation of the diversity of local cultures. Major global companies must recognise that policies need to be managed with the broad context of business strategy and integrated into the work culture with the support of all elements of human resources management. Most currently, companies are accommodating national cultural differences while preserving work culture principals that encourage people to effectively execute the company's strategic objectives. Even to the casual observer, it is apparent that culture- a society's programming of the mind- has both a pervasive and changing influence on each national business environment. Global managers must recognise the influence of culture and be prepared to either respond to it or change it. This book examines current research in the study of managerial technology transfer.

  8. Knowledge Transfer Services

    Directory of Open Access Journals (Sweden)

    Albert Simard

    2009-03-01

    Full Text Available Le présent article décrit un modèle visant à faciliter la compréhension du processus de transfert du contenu depuis sa source jusqu’à son utilisation. Un groupe de travail de Ressources naturelles Canada a étudié la nature du transfert des savoirs à l’aide d’un modèle de services, afin de découvrir et comprendre les modèles et processus sous-jacents. Les services de savoir sont des programmes qui créent et fournissent des produits organisationnels basés sur un contenu et ayant une valeur intégrée. Ces programmes sont destinés à être utilisés en interne ou transférés pour répondre aux souhaits et besoins d’un utilisateur externe. Les critères de conception du modèle sont les suivants : indépendance par rapport au contenu, concentration sur l’organisation, évolutivité, deux pilotes et deux niveaux de résolution. Le modèle est basé sur une chaîne de valeur dans laquelle la valeur est intégrée, déplacée ou extraite. Un système de services de savoir se divise en neuf étapes : générer, transformer, gérer, utiliser en interne, transférer, ajouter de la valeur, utiliser professionnellement, utiliser personnellement et évaluer. Les services de savoir sont fournis par l’intermédiaire d’un spectre de distribution allant de complexe à accessible. À chaque région du spectre de distribution correspond une série d’attributs qui influencent la manière dont les services sont fournis.This paper describes a model intended to increase understanding of how content is transferred from its source to its use. A Natural Resources Canada task group explored the nature of knowledge transfer with a services paradigm to discover and understand underlying patterns and processes. Knowledge Services are programs that produce and pro-vide content-based organizational outputs with embedded value that are intended to be used internally or transferred to meet external user wants or needs. Model design criteria

  9. Transfer Pricing and FDI

    Directory of Open Access Journals (Sweden)

    Patricia-Sabina Macelaru

    2013-08-01

    Full Text Available FDI analysis is usually performed within the frame of the win-win hypothesis. However, we believe that certain circumstances (MNEs following their own business objectives, lack of appropriate regulations, non-observance of the arm’s length principle may generate disproportionate advantages at the level of FDI stakeholders. The disequilibrium between reinvested profits and repatriated profits may be viewed as a proof of such disproportionate advantages of stakeholders involved in FDI. In addition to figures showing the comparison between reinvested and repatriated profits, as well as the way in which such indicators vary e.g. in case of abnormal business conditions (global economy collapse, we try to show that lack/misuse of transfer pricing regulations may generate even more disequilibrium, the MNEs using intra-group transactions as an additional way of repatriating non-taxable/low tax profits.

  10. Technology transfer packages

    International Nuclear Information System (INIS)

    Mizon, G.A.; Bleasdale, P.A.

    1994-01-01

    Nuclear power is firmly established in many developed countries'energy policies and is being adopted by emerging nations as an attractive way of gaining energy self sufficiency. The early users of nuclear power had to develop the technology that they needed, which now, through increasing world wide experience, has been rationalised to meet demanding economic and environmental pressures. These justifiable pressures, can lead to existing suppliers of nuclear services to consider changing to more appropriate technologies and for new suppliers to consider licensing proven technology rather then incurring the cost of developing new alternatives. The transfer of technology, under license, is made more straight forward if the owner conveniently groups appropriate technology into packages. This paper gives examples of 'Technology Packages' and suggests criteria for the specification, selection and contractual requirements to ensure successful licensing

  11. Technology transfer 1995

    Energy Technology Data Exchange (ETDEWEB)

    1995-01-01

    Technology Transfer 1995 is intended to inform the US industrial and academic sectors about the many opportunities they have to form partnerships with the US Department of Energy (DOE) for the mutual advantage of the individual institutions, DOE, and the nation as a whole. It also describes some of the growing number of remarkable achievements resulting from such partnerships. These partnership success stories offer ample evidence that Americans are learning how to work together to secure major benefits for the nation--by combining the technological, scientific, and human resources resident in national laboratories with those in industry and academia. The benefits include more and better jobs for Americans, improved productivity and global competitiveness for technology-based industries, and a more efficient government laboratory system.

  12. Dual Space Technology Transfer

    Science.gov (United States)

    Kowbel, W.; Loutfy, R.

    2009-03-01

    Over the past fifteen years, MER has had several NASA SBIR Phase II programs in the area of space technology, based upon carbon-carbon (C-C) composites. In addition, in November 2004, leading edges supplied by MER provided the enabling technology to reach a Mach 10 record for an air breathing engine on the X-43 A flight. The MER business model constitutes a spin-off of technologies initially by incubating in house, and ultimately creating spin-off stand alone companies. FMC was formed to provide for technology transfer in the area of fabrication of C-C composites. FMC has acquired ISO 9000 and AS9100 quality certifications. FMC is fabricating under AS9100 certification, flight parts for several flight programs. In addition, FMC is expanding the application of carbon-carbon composites to several critical military programs. In addition to space technology transfer to critical military programs, FMC is becoming the world leader in the commercial area of low-cost C-C composites for furnace fixtures. Market penetrations have been accomplished in North America, Europe and Asia. Low-cost, quick turn-around and excellent quality of FMC products paves the way to greatly increased sales. In addition, FMC is actively pursuing a joint venture with a new partner, near closure, to become the leading supplier of high temperature carbon based composites. In addition, several other spin-off companies such as TMC, FiC, Li-Tech and NMIC were formed by MER with a plethora of potential space applications.

  13. Transfer of fuel assemblies

    International Nuclear Information System (INIS)

    Vuckovich, M.; Burkett, J. P.; Sallustio, J.

    1984-01-01

    Fuel assemblies of a nuclear reactor are transferred during fueling or refueling or the like by a crane. The work-engaging fixture of the crane picks up an assembly, removes it from this slot, transfers it to the deposit site and deposits it in its slot at the deposit site. The control for the crane includes a strain gauge connected to the crane line which raises and lowers the load. The strain gauge senses the load on the crane. The signal from the strain gauge is compared with setpoints; a high-level setpoint, a low-level setpoint and a slack-line setpoint. If the strain gauge signal exceeds the high-level setpoint, the line drive is disabled. This event may occur during raising of a fuel assembly which encounters resistance. The high-level setpoint may be overridden under proper precautions. The line drive is also disabled if the strain gauge signal is less than the low-level setpoint. This event occurs when a fuel assembly being deposited contacts the bottom of its slot or an obstruction in, or at the entry to the slot. To preclude lateral movement and possible damage to a fuel assembly suspended from the crane line, the traverse drive of the crane is disabled once the strain-gauge exceets the lov-level setpoint. The traverse drive can only be enabled after the strain-gauge signal is less than the slack-line set-point. This occurs when the lines has been set in slack-line setting. When the line is tensioned after slack-li ne setting, the traverse drive remains enabled only if the line has been disconnected from the fuel assembly

  14. Technology transfer from nuclear research

    International Nuclear Information System (INIS)

    1989-01-01

    A number of processes, components and instruments developed at the Bhabha Atomic Research Centre, (BARC), Bombay, find application in industry and are available for transfer to private or public sector undertakings for commercial exploitation. The Technology Transfer Group (TTG) constituted in January 1980 identifies such processes and prototypes which can be made available for transfer. This catalogue contains brief descriptions of such technologies and they are arranged under three groups, namely, Group A containing descriptions of technologies already transferred, Group B containing descriptions of technologies ready for transfer and Group C containing descriptions of technology transfer proposals being processed. The position in the above-mentioned groups is as on 1 March 1989. The BARC has also set up a Technology Corner where laboratory models and prototypes of instruments, equipment and components are displayed. These are described in the second part of the catalogue. (M.G.B.)

  15. Towards Improving the Transfer of Care of Kidney Transplant Recipients.

    Science.gov (United States)

    Gill, J S; Wright, A J; Delmonico, F L; Newell, K A

    2017-01-01

    Kidney transplant recipients require specialized medical care and may be at risk for adverse health outcomes when their care is transferred. This document provides opinion-based recommendations to facilitate safe and efficient transfers of care for kidney transplant recipients including minimizing the risk of rejection, avoidance of medication errors, ensuring patient access to immunosuppressant medications, avoidance of lapses in health insurance coverage, and communication of risks of donor disease transmission. The document summarizes information to be included in a medical transfer document and includes suggestions to help the patient establish an optimal therapeutic relationship with their new transplant care team. The document is intended as a starting point towards standardization of transfers of care involving kidney transplant recipients. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  16. Prospects for Money Transfer Models

    OpenAIRE

    Yougui Wang; Ning Ding; Ning Xi

    2005-01-01

    Recently, in order to explore the mechanism behind wealth or income distribution, several models have been proposed by applying principles of statistical mechanics. These models share some characteristics, such as consisting of a group of individual agents, a pile of money and a specific trading rule. Whatever the trading rule is, the most noteworthy fact is that money is always transferred from one agent to another in the transferring process. So we call them money transfer models. Besides e...

  17. Transfer maps and projection formulas

    OpenAIRE

    Tabuada, Goncalo

    2010-01-01

    Transfer maps and projection formulas are undoubtedly one of the key tools in the development and computation of (co)homology theories. In this note we develop an unified treatment of transfer maps and projection formulas in the non-commutative setting of dg categories. As an application, we obtain transfer maps and projection formulas in algebraic K-theory, cyclic homology, topological cyclic homology, and other scheme invariants.

  18. Energy transfer properties and mechanisms

    International Nuclear Information System (INIS)

    Barker, J.R.

    1993-01-01

    Since no single experimental technique is the best method for energy transfer experiments, we have used both time-dependent infrared fluorescence (IRF) and time-dependent thermal lensing (TDTL) to study energy transfer in various systems. We are investigating pump-probe techniques employing resonance enhanced multiphoton ionization (REMPI). IRF was used to study benzene, azulene, and toluene. TDTL was used to study CS 2 and SO 2 (data not given for latter). Large molecule energy transfer mechanisms are discussed. 10 figs

  19. ASPECTS REGARDING THE SHARE TRANSFER

    Directory of Open Access Journals (Sweden)

    Cristina Cojocaru

    2015-11-01

    Full Text Available Throughout its content, the memorandum of association, even in the case of a limited liability company, stipulates the contribution of each shareholder to the share capital while the share capital is divided into shares, corresponding to the contribution of each shareholder to the share capital. The limited liability company is established in consideration of the people who set it up and as such, the share transfer is subject to certain conditions provided by law. Therefore, the law sets out strict conditions for share transfer in the case the transfer is done to one or more shareholders, but especially if the transfer is done to people outside the company, or following the inheritance. If the transfer is done to a shareholder, such is possible provided that this transfer has not been prohibited by the act of incorporation itself. Instead, the transfer to people outside the company cannot be done without the cons ent of shareholders representing at least three quarters of the capital. In case of share transfer by succession, the law allows it provided that this transfer is permitted within the memorandum of association .

  20. Analysis of transference in Gestalt group psychotherapy.

    Science.gov (United States)

    Frew, J E

    1990-04-01

    In Gestalt therapy, transference is viewed as a contact boundary disturbance which impairs the patient's ability to accurately perceive the present therapy situation. The boundary disturbances in Gestalt therapy most closely related to the analytic notion of transference are projection, introjection, and confluence. In Gestalt group psychotherapy, group members interfere with the process of need identification and satisfaction by distorting their contact with each other through projecting, introjecting, and being confluent. The Gestalt group therapist uses interventions directed to individuals and to the group to increase participants' awareness of these boundary disturbances and of the present contact opportunities available to them when these disturbances are resolved. In formulating interventions, the leader is mindful of the function of boundary disturbances to the group-as-a-whole as well as to individuals.

  1. Utrecht Radiative Transfer Courses

    Science.gov (United States)

    Rutten, R. J.

    2003-01-01

    The Utrecht course ``The Generation and Transport of Radiation'' teaches basic radiative transfer to second-year students. It is a much-expanded version of the first chapter of Rybicki & Lightman's ``Radiative Processes in Astrophysics''. After this course, students understand why intensity is measured per steradian, have an Eddington-Barbier feel for optically thick line formation, and know that scattering upsets LTE. The text is a computer-aided translation by Ruth Peterson of my 1992 Dutch-language course. My aim is to rewrite this course in non-computer English and make it web-available at some time. In the meantime, copies of the Peterson translation are made yearly at Uppsala -- ask them, not me. Eventually it should become a textbook. The Utrecht course ``Radiative Transfer in Stellar Atmospheres'' is a 30-hour course for third-year students. It treats NLTE line formation in plane-parallel stellar atmospheres at a level intermediate between the books by Novotny and Boehm-Vitense, and Mihalas' ``Stellar Atmospheres''. After this course, students appreciate that epsilon is small, that radiation can heat or cool, and that computers have changed the field. This course is web-available since 1995 and is regularly improved -- but remains incomplete. Eventually it should become a textbook. The three Utrecht exercise sets ``Stellar Spectra A: Basic Line Formation'', ``Stellar Spectra B: LTE Line Formation'', and ``Stellar Spectra C: NLTE Line Formation'' are IDL-based computer exercises for first-year, second-year, and third-year students, respectively. They treat spectral classification, Saha-Boltzmann population statistics, the curve of growth, the FAL-C solar atmosphere model, the role of H-minus in the solar continuum, LTE formation of Fraunhofer lines, inversion tactics, the Feautrier method, classical lambda iteration, and ALI computation. The first two sets are web-available since 1998; the third will follow. Acknowledgement. Both courses owe much to previous

  2. Pregnancy and Multiple Births rate after Transferring 2 or 3 Embryos

    Directory of Open Access Journals (Sweden)

    F Mostajeran

    2006-05-01

    Full Text Available Background: In vitro fertilization (IVF is a progressing common reproduction method and if the number of transferred embryo increases, the pregnancy rate and multiple pregnancies will increase which may lead to higher medical costs and human suffering. We compared pregnancy and multiple pregnancies rate after two or three transferred embryo via IVF. Methods: From April 2003 to June 2004, 301 referred infertile women to Isfahan infertility center underwent IVF with transferring two or three good quality embryos. Results: From 298 patients, 2 and 3 embryos were transferred in 155 patients and in 143 patients, respectively. Pregnancy rate was 19.4% versus 24.5% in 2 and 3 embryos transferred patients, respectively. Twin gestations were found in 5(3.2% of 2 embryos transferred patients and in 11(7.7% of 3 embryos transferred patients. Discussion: Transferring two or three embryos with good quality increase the rate of twin gestations in young women, without significant improve in the chance of singleton conception. Key words: In Vitro Fertilization, Multiple gestations, Embryo transfer

  3. The block transfer system

    International Nuclear Information System (INIS)

    Bradish, G.J. III; Reid, A.E.

    1986-01-01

    The central instrumentation control and data acquisition (CICADA) computer system is comprised of a functionally distributed hierarchical network of thirteen (13) 32-bit mini-computers that are the heart of the control, monitoring, data collection and data analysis for the tokamak fusion test reactor (TFTR). The CICADA system was designed with the goal of providing complete control, monitoring, and data acquisition for TFTR, which includes the acquisition and storage of 20M points of data within a five-minute shot cycle. It was realized early in the system design that in order to meet this goal an ancillary system would have to be provided to supplement the subsystem CAMAC systems that, due to the relatively slow throughput of the serial highways and the overhead of relaying data to the central facilities within a star network, would not provide the necessary throughput. The authors discuss how the block transfer system provided a means of moving data directly from the CAMAC crate to the application running on the central facility computers

  4. Heat transfer and fire spread

    Science.gov (United States)

    Hal E. Anderson

    1969-01-01

    Experimental testing of a mathematical model showed that radiant heat transfer accounted for no more than 40% of total heat flux required to maintain rate of spread. A reasonable prediction of spread was possible by assuming a horizontal convective heat transfer coefficient when certain fuel and flame characteristics were known. Fuel particle size had a linear relation...

  5. Providing global WLCG transfer monitoring

    International Nuclear Information System (INIS)

    Andreeva, J; Dieguez Arias, D; Campana, S; Keeble, O; Magini, N; Molnar, Z; Ro, G; Saiz, P; Salichos, M; Tuckett, D; Flix, J; Oleynik, D; Petrosyan, A; Uzhinsky, A; Wildish, T

    2012-01-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being re-used. The paper describes the architecture of the Global Transfer monitoring system, the implementation of its components and the first prototype.

  6. Green Wireless Power Transfer Networks

    NARCIS (Netherlands)

    Liu, Q.; Golinnski, M.; Pawelczak, P.; Warnier, M.

    2016-01-01

    wireless power transfer network (WPTN) aims to support devices with cable-less energy on-demand. Unfortunately, wireless power transfer itself-especially through radio frequency radiation rectification-is fairly inefficient due to decaying power with distance, antenna polarization, etc.

  7. Strammere retningslinjer om transfer pricing

    DEFF Research Database (Denmark)

    Rossing, Christian Plesner

    2015-01-01

    Transfer pricing vedrører prisfastsættelsen på transaktioner, der foregår mellem koncernforbundne selskaber og er fortsat et tema, der nyder stort fokus hos både multinationale koncerner og skattemyndigheder. For den multinationale koncern er transfer pricing i høj grad en aktivitet, der består i...

  8. Proton transfer events in GFP

    NARCIS (Netherlands)

    Di Donato, M.; van Wilderen, L.J.G.W.; van Stokkum, I.H.M.; Cohen Stuart, T.A.; Kennis, J.T.M.; Hellingwerf, K.J.; van Grondelle, R.; Groot, M.L.

    2011-01-01

    Proton transfer is one of the most important elementary processes in biology. Green fluorescent protein (GFP) serves as an important model system to elucidate the mechanistic details of this reaction, because in GFP proton transfer can be induced by light absorption. Illumination initiates proton

  9. Transfer mellem uddannelse og arbejde

    DEFF Research Database (Denmark)

    Wahlgren, Bjarne

    Rapporten sammenfatter eksisterende forskning om faktorer, der bidrager til transfer, altså faktorer som bidrager til, at det, vi lærer i undervisningen, efterfølgende anvendes i en arbejdssituation. Forskningsoversigten præsenterer emririsk funderede resultater om, hvad vi ved om transfer. Den t...

  10. Clinical Outcomes following median to radial nerve transfers

    Science.gov (United States)

    Ray, Wilson Z.; Mackinnon, Susan E.

    2010-01-01

    Purpose In this study the authors evaluate the clinical outcomes in patients with radial nerve palsy who underwent nerve transfers utilizing redundant fascicles of median nerve (innervating the flexor digitorum superficialis and flexor carpi radialis muscles) to the posterior interosseous nerve and the nerve to the extensor carpi radialis brevis. Methods A retrospective review of the clinical records of 19 patients with radial nerve injuries who underwent nerve transfer procedures using the median nerve as a donor nerve were included. All patients were evaluated using the Medical Research Council (MRC) grading system. Results The mean age of patients was 41 years (range 17 – 78 years). All patients received at least 12 months of follow-up (20.3 ± 5.8 months). Surgery was performed at a mean of 5.7 ± 1.9 months post-injury. Post-operative functional evaluation was graded according to the following scale: grades MRC 0/5 - MRC 2/5 were considered poor outcomes, while MRC of 3/5 was a fair result, MRC grade 4/5 was a good result, and grade 4+/5 was considered an excellent outcome. Seventeen patients (89%) had a complete radial nerve palsy while two patients (11%) had intact wrist extension but no finger or thumb extension. Post-operatively all patients except one had good to excellent recovery of wrist extension. Twelve patients recovered good to excellent finger and thumb extension, two patients had fair recovery, five patients had a poor recovery. Conclusions The radial nerve is a commonly injured nerve, causing significant morbidity in affected patients. The median nerve provides a reliable source of donor nerve fascicles for radial nerve reinnervation. This transfer was first performed in 1999 and evolved over the subsequent decade. The important nuances of both surgical technique and motor re-education critical for to the success of this transfer have been identified and are discussed. PMID:21168979

  11. Lunar Cube Transfer Trajectory Options

    Science.gov (United States)

    Folta, David; Dichmann, Donald James; Clark, Pamela E.; Haapala, Amanda; Howell, Kathleen

    2015-01-01

    Numerous Earth-Moon trajectory and lunar orbit options are available for Cubesat missions. Given the limited Cubesat injection infrastructure, transfer trajectories are contingent upon the modification of an initial condition of the injected or deployed orbit. Additionally, these transfers can be restricted by the selection or designs of Cubesat subsystems such as propulsion or communication. Nonetheless, many trajectory options can b e considered which have a wide range of transfer duration, fuel requirements, and final destinations. Our investigation of potential trajectories highlights several options including deployment from low Earth orbit (LEO) geostationary transfer orbits (GTO) and higher energy direct lunar transfer and the use of longer duration Earth-Moon dynamical systems. For missions with an intended lunar orbit, much of the design process is spent optimizing a ballistic capture while other science locations such as Sun-Earth libration or heliocentric orbits may simply require a reduced Delta-V imparted at a convenient location along the trajectory.

  12. Innovation through Knowledge Transfer 2012

    CERN Document Server

    Gabrys, Bogdan; Musial-Gabrys, Katarzyna; Roach, Jim; Innovation through Knowledge Transfer InnovationKT-2012

    2013-01-01

    Across the world there is growing awareness of the importance of innovation and knowledge transfer.  Innovation in the sense of generating new knowledge and making better use of existing knowledge, coupled with knowledge transfer and sharing paradigms, have never been more relevant to the universities, industry, commerce and the third sector.  This volume represents the proceedings of the Innovation through Knowledge Transfer 2012 Conference which formed an excellent opportunity to disseminate, share and discuss the impact of innovation, knowledge sharing, enterprise and entrepreneurship.  The volume contains papers presented at a Workshop on ‘The Meta Transfer of Knowledge: Challenges in the Transfer of Knowledge in Industry’, others from thematic sessions on ‘Next-Practice in University Based Open Innovation’,  ‘Social Innovation and Related Paradigms’, ‘Engagement with Industry and Commerce’ and ‘Knowledge Exchange’.  All papers were thoroughly reviewed by referees knowledgeable in...

  13. Involuntary transfer of Intellectual property

    Directory of Open Access Journals (Sweden)

    Saeed habiba

    2011-07-01

    Full Text Available IPR owners have a right about voluntary transfer but sometimes Intellectual property right transfer by force and thus, there are challenge that this article regard for its. IPR shall be devolved to their legitimate heirs after their death unless, owner indicate otherwise in their wills. The heirs have the exclusive right to exercise economic and moral rights, they decide upon publication of the work and in general do every exploitation. But, they shall exercise The decisive manner that IPR of holder intended before his death. On other hand, IPR may be liable to seizure or IPR have been used in mortgage loan. Thus they can be transfer to new person.Here, we regard to Involuntary transfer.This article highlight subject of involuntary transfer and analysis on aspects

  14. Cash transfers and domestic violence.

    Science.gov (United States)

    Hidrobo, Melissa; Fernald, Lia

    2013-01-01

    Violence against women is a major health and human rights problem yet there is little rigorous evidence as to how to reduce it. We take advantage of the randomized roll-out of Ecuador's cash transfer program to mothers to investigate how an exogenous increase in a woman's income affects domestic violence. We find that the effect of a cash transfer depends on a woman's education and on her education relative to her partner's. Our results show that for women with greater than primary school education a cash transfer significantly decreases psychological violence from her partner. For women with primary school education or less, however, the effect of a cash transfer depends on her education relative to her partner's. Specifically, the cash transfer significantly increases emotional violence in households where the woman's education is equal to or more than her partner's. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Effect of hyaluronic acid-enriched transfer medium on frozen-thawed embryo transfer outcomes.

    Science.gov (United States)

    Fu, Wei; Yu, Min; Zhang, Xiao-Jin

    2018-04-01

    To determine if hyaluronic acid-enriched transfer medium (HETM) affects the implantation rate (IR) and clinical pregnancy rate (PR) in women undergoing frozen-thawed embryo transfer (FET). The records of women who underwent FET from May 2014 to October 2014 were retrospectively reviewed. Outcome measures were IR and PR. In all 1721 cycles of 1632 patients were included in this study. HETM was used for 347 cycles of 342 patients, and standard medium for 1374 cycles of 1290 patients. Overall, FET outcomes were similar between the groups. For patients undergoing their first FET attempt, the IR (24.3% vs 31.6%, P = 0.042) and clinical PR (34.3% vs 50.1%, P = 0.004) were lower in the HETM group. For patients undergoing their second FET attempt, pregnancy outcomes were similar between the groups. For patients undergoing their third or more FET attempt, HETM was associated with a higher IR (33.3% vs 16.4%, P Gynecology.

  16. Fuel pin transfer tool

    International Nuclear Information System (INIS)

    Patenaude, R. S.

    1985-01-01

    A fuel pin transfer tool has a latching device of the collet type attached to a first member movable vertically through a long work stroke enabling a fuel pin in an under water assembly to be engaged and withdrawn therefrom or placed therein and released. The latching device has a collet provided with a plurality of resilient fingers having cam portions normally spaced apart to receive the upper end of a fuel pin between them and a second member, movable vertically through a short stroke relative to the first member is provided with cam portions engageable with those of the fingers and is yieldably and resiliently held in a raised position in which its cam portions engage those of the fingers and force the fingers into their pin-gripping positions. When a predetermined force is applied to the second member, it is so moved that its cam portions are disengaged from the cam portions of the fingers permitting the latter to move into their normal relationship in which a gripped pin is released or another pin received but with their pin-gripping relationship positively re-established and maintained once the force on the tubular member is lessened. Movement of the first member in either direction and movement of the second member into its raised position is attended by forces inadequate to affect the integrity of fuel pin cladding. That force is applied in the preferred embodiment, by a power operated actuator which is within the upper portion of a housing and, in the preferred embodiment, carried by the long stroke member but always in the upper housing portion which is of a material sufficiently translucent to enable the actuator to be observed throughout the work stroke and is sufficiently light in weight to prevent the tool from being top heavy

  17. [Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea].

    Science.gov (United States)

    Baldé, I S; Diallo, F B; Diallo, Y; Diallo, A; Diallo, M H; Camara, M K; Sy, T; Diallo, M S

    2011-12-01

    The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

  18. Entanglement transfer between bipartite systems

    International Nuclear Information System (INIS)

    Bougouffa, Smail; Ficek, Zbigniew

    2012-01-01

    The problem of a controlled transfer of an entanglement initially encoded into two two-level atoms that are successively sent through two single-mode cavities is investigated. The atoms and the cavity modes form a four-qubit system and we demonstrate the conditions under which the initial entanglement encoded into the atoms can be completely transferred to other pairs of qubits. We find that in the case of non-zero detuning between the atomic transition frequencies and the cavity mode frequencies, no complete transfer of the initial entanglement is possible to any of the other pairs of qubits. In the case of exact resonance and equal coupling strengths of the atoms to the cavity modes, an initial maximally entangled state of the atoms can be completely transferred to the cavity modes. Complete transfer of the entanglement is restricted to the cavity modes, with transfer to the other pairs being limited to 50%. We find that complete transfer of an initial entanglement to other pairs of qubits may take place if the initial state is not the maximally entangled state and the atoms couple to the cavity modes with unequal strengths. Depending on the ratio between the coupling strengths, optimal entanglement can be created between the atoms and one of the cavity modes.

  19. Transfer Pricing - An Innovative Approach

    Directory of Open Access Journals (Sweden)

    Ramona MAXIM

    2017-06-01

    Full Text Available This paper presents transfer pricing and elements of drafting the transfer pricing file by the big companies. The transfer pricing procedure was founded based upon Order no. 442/2016 and the Fiscal Procedure Code and it represents a method upon which the tax base is transferred from a high tax country to a country with low taxation. This legislation outlines the conditions which companies must observe in order to draft the transfer pricing documentation and the significance thresholds. The purpose to draft a transfer pricing file is to reduce the differences between prices and market value and the actual results of company taxation. Economic double taxation occurs when tax authorities apply price adjustments because the company did not respect the principle of market value. Keeping records of transfer pricing and practicing a price aligned to market requirements contribute to an understanding of business development and the creation of appropriate tax planning. Taking into account all these aspects and the fact that any taxpayer is tempted to pay the lowest possible fees, tax havens become an option. In this context we can speak of a tax haven as a loophole in the use of the market price.

  20. Debugging data transfers in CMS

    International Nuclear Information System (INIS)

    Bagliesi, G; Belforte, S; Bloom, K; Bockelman, B; Bonacorsi, D; Fisk, I; Flix, J; Hernandez, J; D'Hondt, J; Maes, J; Kadastik, M; Klem, J; Kodolova, O; Kuo, C-M; Letts, J; Magini, N; Metson, S; Piedra, J; Pukhaeva, N; Tuura, L

    2010-01-01

    The CMS experiment at CERN is preparing for LHC data taking in several computing preparation activities. In early 2007 a traffic load generator infrastructure for distributed data transfer tests was designed and deployed to equip the WLCG tiers which support the CMS virtual organization with a means for debugging, load-testing and commissioning data transfer routes among CMS computing centres. The LoadTest is based upon PhEDEx as a reliable, scalable data set replication system. The Debugging Data Transfers (DDT) task force was created to coordinate the debugging of the data transfer links. The task force aimed to commission most crucial transfer routes among CMS tiers by designing and enforcing a clear procedure to debug problematic links. Such procedure aimed to move a link from a debugging phase in a separate and independent environment to a production environment when a set of agreed conditions are achieved for that link. The goal was to deliver one by one working transfer routes to the CMS data operations team. The preparation, activities and experience of the DDT task force within the CMS experiment are discussed. Common technical problems and challenges encountered during the lifetime of the taskforce in debugging data transfer links in CMS are explained and summarized.

  1. The development of nuclear technology transfer

    International Nuclear Information System (INIS)

    Nack-chung Sung

    1987-01-01

    Korea, as a recipient of nuclear technology transfer, has good experience of progressively building up its indigeneous capability of nuclear technology through three stages of technology transfer, namely: technology transfer under the turnkey approach, component approach, and integrated technology transfer with a local prime contractor. Here, each stage of experience of technology transfer, with Korea as a recipient, is presented. (author)

  2. Salvage of cervical motor radiculopathy using peripheral nerve transfer reconstruction.

    Science.gov (United States)

    Afshari, Fardad T; Hossain, Taushaba; Miller, Caroline; Power, Dominic M

    2018-05-10

    Motor nerve transfer surgery involves re-innervation of important distal muscles using either an expendable motor branch or a fascicle from an adjacent functioning nerve. This technique is established as part of the reconstructive algorithm for traumatic brachial plexus injuries. The reproducible outcomes of motor nerve transfer surgery have resulted in exploration of the application of this technique to other paralysing conditions. The objective of this study is to report feasibility and increase awareness about nerve transfer as a method of improving upper limb function in patients with cervical motor radiculopathy of different aetiology. In this case series we report 3 cases with different modes of injury to the spinal nerve roots with significant and residual motor radiculopathy that have been successfully treated with nerve transfer surgery with good functional outcomes. The cases involved iatrogenic nerve root injury, tumour related root compression and degenerative root compression. Nerve transfer surgery may offer reliable reconstruction for paralysis when there has been no recovery following a period of conservative management. However the optimum timing of nerve transfer intervention is not yet identified for patients with motor radiculopathy.

  3. Coherently Enhanced Wireless Power Transfer

    OpenAIRE

    Krasnok, Alex; Baranov, Denis G.; Generalov, Andrey; Li, Sergey; Alu, Andrea

    2017-01-01

    Extraction of electromagnetic energy by an antenna from impinging external radiation is at the basis of wireless communications and power transfer (WPT). The maximum of transferred energy is ensured when the antenna is conjugately matched, i.e., when it is resonant and it has an equal coupling with free space and its load, which is not easily implemented in near-field WPT. Here, we introduce the concept of coherently enhanced wireless power transfer. We show that a principle similar to the on...

  4. Nucleon transfer between heavy nuclei

    International Nuclear Information System (INIS)

    Von Oertzen, W.

    1984-02-01

    Nucleon transfer reactions between heavy nuclei are characterized by the classical behaviour of the scattering orbits. Thus semiclassical concepts are well suited for the description of these reactions. In the present contribution the characteristics of single and multinucleon transfer reactions at energies below and above the Coulomb barrier are shown for systems like Sn+Sn, Xe+U and Ni+Pb. The role of the pairing interaction in the transfer of nucleon pairs is illustrated. For strong transitions the coupling of channels and the absorption into more complicated channels is taken into account in a coupled channels calculation

  5. Mandibular reconstruction with composite microvascular tissue transfer

    International Nuclear Information System (INIS)

    Coleman, J.J. III; Wooden, W.A.

    1990-01-01

    Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons [lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)]. Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure

  6. Mandibular reconstruction with composite microvascular tissue transfer

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, J.J. III; Wooden, W.A. (Emory Univ. School of Medicine, Atlanta, GA (USA))

    1990-10-01

    Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons (lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)). Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure.

  7. Interhospital transfer delays emergency abdominal surgery and prolongs stay.

    Science.gov (United States)

    Limmer, Alexandra M; Edye, Michael B

    2017-11-01

    Interhospital transfer of patients requiring emergency surgery is common practice. It has the potential to delay surgical intervention, increase rate of complications and thus length of hospital stay. A retrospective cohort study was conducted of adult patients who underwent emergency surgery for abdominal pain at a large metropolitan hospital in New South Wales (Hospital A) in 2013. The impact of interhospital transfer on time to surgical intervention, post-operative length of stay and overall length of stay was assessed. Of the 910 adult patients who underwent emergency surgery for abdominal pain at Hospital A in 2013, 31.9% (n = 290) were transferred by road ambulance from a local district hospital (Hospital B). The leading surgical procedures performed were appendicectomy (n = 299, 32.9%), cholecystectomy (n = 174, 19.1%), gastrointestinal endoscopy (n = 95, 10.4%), cystoscopy (n = 86, 9.5%), hernia repair (n = 45, 4.9%), salpingectomy (n = 19, 2.1%) and oversewing of perforated peptic ulcer (n = 13, 1.4%). Overall, interhospital transfer (n = 290, 31.9%) was associated with increases in mean time to surgical intervention (14.2 h, P < 0.001), post-operative length of stay (1.1 days, P = 0.001) and overall length of stay (1.6 days, P < 0.001). Delayed surgical intervention was observed across all procedure types except surgery for perforated peptic ulcer, where transferred patients underwent surgery within a comparable timeframe to direct admissions. Interhospital transfer delays surgical intervention and increases length of hospital stay. This mandates attention due to the implications for patient outcomes and added burden to the healthcare system. The system did, however, show capability to appropriately expedite surgery for acutely life-threatening cases. © 2016 Royal Australasian College of Surgeons.

  8. Stem cell collection and gene transfer in Fanconi anemia.

    Science.gov (United States)

    Kelly, Patrick F; Radtke, Susan; von Kalle, Christof; Balcik, Brenden; Bohn, Kimberley; Mueller, Robin; Schuesler, Todd; Haren, Moira; Reeves, Lilith; Cancelas, Jose A; Leemhuis, Thomas; Harris, Richard; Auerbach, Arleen D; Smith, Franklin O; Davies, Stella M; Williams, David A

    2007-01-01

    Fanconi anemia (FA) is a rare genetic syndrome characterized by progressive bone marrow failure (BMF), congenital anomalies, and a predisposition to malignancy. Successful gene transfer into hematopoietic stem cells (HSCs) could reverse BMF in this disease. We developed clinical trials to determine whether a sufficient number of CD34(+) stem cells could be collected for gene modification and to evaluate the safety and efficacy of HSC-corrective gene transfer in FA genotype A (FANCA) patients. Here, we report that FA patients have significant depletion of their BM CD34(+) cell compartment even before severe pancytopenia is present. However, oncoretroviral-mediated ex vivo gene transfer was efficient in clinical scale in FA-A cells, leading to reversal of the cellular phenotype in a significant percentage of CD34(+) cells. Re-infusion of gene-corrected products in two patients was safe and well tolerated and accompanied by transient improvements in hemoglobin and platelet counts. Gene correction was transient, likely owing to the low dose of gene-corrected cells infused. Our early experience shows that stem cell collection is well tolerated in FA patients and suggests that collection be considered as early as possible in patients who are potential candidates for future gene transfer trials.

  9. Trends in CD4 cell count response to first-line antiretroviral treatment in HIV-positive patients from Asia, 2003-2013: TREAT Asia HIV Observational Database Low Intensity Transfer.

    Science.gov (United States)

    De La Mata, Nicole L; Ly, Penh S; Ng, Oon T; Nguyen, Kinh V; Merati, Tuti P; Pham, Thuy T; Lee, Man P; Choi, Jun Y; Sohn, Annette H; Law, Matthew G; Kumarasamy, Nagalingeswaran

    2017-11-01

    Antiretroviral treatment (ART) guidelines have changed over the past decade, recommending earlier initiation and more tolerable regimens. The study objective was to examine the CD4 response to ART, depending on the year of ART initiation, in HIV-positive patients in the Asia-Pacific. We included HIV-positive adult patients who initiated ART between 2003 and 2013 in our regional cohort from eight urban referral centres in seven countries within Asia. We used mixed-effects linear regression models to evaluate differences in CD4 response by year of ART initiation during 36 months of follow-up, adjusted a priori for other covariates. Overall, 16,962 patients were included. Patients initiating in 2006-9 and 2010-13 had an estimated mean CD4 cell count increase of 8 and 15 cells/µl, respectively, at any given time during the 36-month follow-up, compared to those in 2003-5. The median CD4 cell count at ART initiation also increased from 96 cells/µl in 2003-5 to 173 cells/µl in 2010-13. Our results suggest that the CD4 response to ART is modestly higher for those initiating ART in more recent years. Moreover, fewer patients are presenting with lower absolute CD4 cell counts over time. This is likely to reduce their risk of opportunistic infections and future non-AIDS defining cancers.

  10. Using countertransference: analytic contact, projective identification, and transference phantasy states.

    Science.gov (United States)

    Waska, Robert

    2008-01-01

    The influence of projective identification is an integral aspect of most psychoanalytic treatments, not only with patients who are more disturbed, but also with individuals are higher functioning and have neuroses. Projective identification involves both internal relational phantasies of self and object as well as external interactions with the environment. Both elements shape the transference. Continuous projections distort the ego's image of the object, causing introjections that bring increased guilt, anxiety, and envy onto the ego, creating even more radical projections. Consequently, the countertransference is repeatedly stimulated in an evolving or devolving manner (Clarkin, Yeomans, Kernberg, 2006). The case material has illustrated the constant interplay among projective identification, transference, and countertransference as well as the utility of countertransference in making the most helpful interpretations. The concept of analytic contact (Waska, 2006; Waska 2007) was noted as the vehicle of optimal psychological transformation. Rather than an emphasis on frequency, diagnosis, use of couch, or mode of termination, the focus is more on the clinical situation and the moment-to-moment work on internal conflict, unconscious phantasy, destructive defenses, analysis of the transference and extratransference anxieties, and the gradual integration of core object relational experiences. Regarding a more clinical rather than theoretical definition of psychoanalysis, Sandler (1988) states that what truly defines a treatment as psychoanalytic is the analyst's attitudes towards his patient, his willingness to contain and make the effort to patiently understand the patient's unconscious conflicts and reactions to internal phantasy states, the humane detachment and lack of judgment, and the maintenance of a comfortable and safe setting in which the transference can unfold. This definition is certainly similar to the elements of analytic contact. Use of the

  11. Transfer your ideas to society!

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    Science and technology labs are the ideal places for developing innovative solutions. However, inventors sometimes don’t realize that their ideas can find an application in industry, which can in turn have a technical and economic impact on society. Some researchers may think that disclosing an invention is a time-consuming process which is worth doing only in very special cases. But one thing is certain: it is always worth informing the Knowledge and Technology Transfer group, as they will give you the correct advice and support. Don’t be afraid of the paperwork… it can be highly rewarding!   Why should researchers at CERN bother to disclose their inventions to the Knowledge and Technology Transfer Group first? “Because when inventors do so, a process to transfer the technology to industry is set in motion” explains Henning Huuse, Patent Portfolio Manager in the KTT Group. To facilitate this transfer, patent protection can be a useful tool. &...

  12. Technology transfer: The CANDU approach

    International Nuclear Information System (INIS)

    Hart, R.S.

    1998-01-01

    The many and diverse technologies necessary for the design, construction licensing and operation of a nuclear power plant can be efficiently assimilated by a recipient country through an effective technology transfer program supported by the firm long term commitment of both the recipient country organizations and the supplier. AECL's experience with nuclear related technology transfer spans four decades and includes the construction and operation of CANDU plants in five countries and four continents. A sixth country will be added to this list with the start of construction of two CANDU 6 plants in China in early 1997. This background provides the basis for addressing the key factors in the successful transfer of nuclear technology, providing insights into the lessons learned and introducing a framework for success. This paper provides an overview of AECL experience relative to the important factors influencing technology transfer, and reviews specific country experiences. (author)

  13. 76 FR 44761 - Remittance Transfers

    Science.gov (United States)

    2011-07-27

    ... of the Dodd-Frank Act by explicitly referencing remittance transfers services. The amendment to FCU... NCUA issues a final rule as defined by Section 551 of the APA. 5 U.S.C. 551. NCUA has requested a...

  14. Subsidiary Autonomy and Knowledge Transfer

    DEFF Research Database (Denmark)

    Søberg, Peder Veng; Wæhrens, Brian Vejrum

    2015-01-01

    Purpose: This paper explores the effect of subsidiary autonomy on knowledge transfers during captive R&D offshoring to emerging markets. Design/methodology/approach: A framework to this end is developed and illustrated in relation to four cases of captive R&D offshoring to emerging markets....... Findings: Subsidiary autonomy has a mainly negative effect on primary knowledge transfer and a mainly positive effect on reverse knowledge transfer. Newly established R&D subsidiaries in emerging markets need primary knowledge transfer in order to build up their competence before they can add...... to the knowledge level of the MNE. Originality: A dual role of subsidiary autonomy is identified. Gradual increase in R&D subsidiary autonomy is beneficial for subsidiary innovation performance....

  15. [Nuclear transfer and therapeutic cloning].

    Science.gov (United States)

    Xu, Xiao-Ming; Lei, An-Min; Hua, Jin-Lian; Dou, Zhong-Ying

    2005-03-01

    Nuclear transfer and therapeutic cloning have widespread and attractive prospects in animal agriculture and biomedical applications. We reviewed that the quality of oocytes and nuclear reprogramming of somatic donor cells were the main reasons of the common abnormalities in cloned animals and the low efficiency of cloning and showed the problems and outlets in therapeutic cloning, such as some basic problems in nuclear transfer affected clinical applications of therapeutic cloning. Study on isolation and culture of nuclear transfer embryonic stem (ntES) cells and specific differentiation of ntES cells into important functional cells should be emphasized and could enhance the efficiency. Adult stem cells could help to cure some great diseases, but could not replace therapeutic cloning. Ethics also impeded the development of therapeutic cloning. It is necessary to improve many techniques and reinforce the research of some basic theories, then somatic nuclear transfer and therapeutic cloning may apply to agriculture reproduction and benefit to human life better.

  16. Cryogenic Propellant Storage and Transfer

    Data.gov (United States)

    National Aeronautics and Space Administration — Space Flight Demonstration development has been canceled in favor of a ground test bed development for of passive/active cryogenic propellant storage, transfer, and...

  17. Styring af international transfer pricing

    DEFF Research Database (Denmark)

    Reuther, Peter; Rossing, Christian Plesner

    2011-01-01

    Nærværende artikel introducerer international transfer pricing, dels som et skatteretligt fænomen og dels som et værktøj til planlægning og økonomisk styring af koncernforbundne selskaber i en multinational virksomhed (MNV). Med udgangspunkt i en case-analyse af MNV’en gives der et konkret eksempel...... på hvordan transfer pricing håndteres i praksis. Artiklens formål er at give et praktisk eksempel på at transfer pricing handler om at efterleve regler, ikke omgå dem. På baggrund af case-analysen argumenteres der for, at såvel akademikere som praktikere bør tage virksomhedens tilgang til...... international transfer pricing i betragtning, når økonomiske styringssystemer i en MNV skal anvendes til planlægning og opfølgning....

  18. Federal Technology Transfer Act (FTTA)

    Science.gov (United States)

    EPA's Federal Technology Transfer Act (FTTA) is a mechanism with which EPA can patent its inventions and license them to companies, through which innovative technologies can enter the marketplace to improve the environment and human health.

  19. Experimental Evidence on Transfer Pricing

    Directory of Open Access Journals (Sweden)

    Tran Quoc H.

    2016-06-01

    Full Text Available We use incentivized economics experiments to test both the point predictions and comparative static predictions of optimal transfer pricing models, comparing behavior under varying conditions, including wholly versus partially-owned subsidiaries and different tariff and tax rates. As predicted, we find that transfer prices are responsive to relative tax and tariff rates as well as ownership proportions. Additionally, we examine convergence and learning in this setting. While individuals do not choose optimal transfer prices, their choices converge to optimal levels with experience. This paper thus makes two important contributions. First, by comparing behavior with theoretical predictions it provides evidence of whether (and when individuals set transfer prices optimally. Second, by comparing behavior under conditions of full and partial ownership it provides evidence on the impact of policy interventions (like regulating ownership proportions by MNEs on tax revenues.

  20. Oxygen transfer in slurry bioreactors.

    Science.gov (United States)

    Kawase, Y; Moo-Young, M

    1991-04-25

    The oxygen transfer in bioreactors with slurries having a yield stress was investigated. The volumetric mass transfer coefficients in a 40-L bubble column with simulated fermentation broths, the Theological properties of which were represented by the Casson model, were measured. Experimental data were compared with a theoretical correlation developed on the basis of a combination of Higbie's penetration theory and Kolmogoroff's theory of isotropic turbulence. Comparisons between the proposed correlation and data for the simulated broths show good agreement. The mass transfer data for actual mycelial fermentation broths reported previously by the authors were re-examined. Their Theological data was correlated by the Bingham plastic model. The oxygen transfer rate data in the mycelial fermentation broths fit the predictions of the proposed theoretical correlation.

  1. High Power Orbit Transfer Vehicle

    National Research Council Canada - National Science Library

    Gulczinski, Frank

    2003-01-01

    ... from Virginia Tech University and Aerophysics, Inc. to examine propulsion requirements for a high-power orbit transfer vehicle using thin-film voltaic solar array technologies under development by the Space Vehicles Directorate (dubbed PowerSail...

  2. To transfer or not to transfer? Kinematics and laterality quotient predict interlimb transfer of motor learning.

    Science.gov (United States)

    Lefumat, Hannah Z; Vercher, Jean-Louis; Miall, R Chris; Cole, Jonathan; Buloup, Frank; Bringoux, Lionel; Bourdin, Christophe; Sarlegna, Fabrice R

    2015-11-01

    Humans can remarkably adapt their motor behavior to novel environmental conditions, yet it remains unclear which factors enable us to transfer what we have learned with one limb to the other. Here we tested the hypothesis that interlimb transfer of sensorimotor adaptation is determined by environmental conditions but also by individual characteristics. We specifically examined the adaptation of unconstrained reaching movements to a novel Coriolis, velocity-dependent force field. Right-handed subjects sat at the center of a rotating platform and performed forward reaching movements with the upper limb toward flashed visual targets in prerotation, per-rotation (i.e., adaptation), and postrotation tests. Here only the dominant arm was used during adaptation and interlimb transfer was assessed by comparing performance of the nondominant arm before and after dominant-arm adaptation. Vision and no-vision conditions did not significantly influence interlimb transfer of trajectory adaptation, which on average was significant but limited. We uncovered a substantial heterogeneity of interlimb transfer across subjects and found that interlimb transfer can be qualitatively and quantitatively predicted for each healthy young individual. A classifier showed that in our study, interlimb transfer could be predicted based on the subject's task performance, most notably motor variability during learning, and his or her laterality quotient. Positive correlations suggested that variability of motor performance and lateralization of arm movement control facilitate interlimb transfer. We further show that these individual characteristics can predict the presence and the magnitude of interlimb transfer of left-handers. Overall, this study suggests that individual characteristics shape the way the nervous system can generalize motor learning. Copyright © 2015 the American Physiological Society.

  3. Interfacility transfers for US ischemic stroke and TIA, 2006-2014.

    Science.gov (United States)

    George, Benjamin P; Doyle, Sara J; Albert, George P; Busza, Ania; Holloway, Robert G; Sheth, Kevin N; Kelly, Adam G

    2018-05-01

    To investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA. We performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006-2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time. The population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 ( p trend TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0-3.8) in 2006 to 7.6 (95% CI 7.2-7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0-10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1-33.3) (2006-2014) ( p trend TIA increased threefold (2006-2014). Interfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system. © 2018 American Academy of Neurology.

  4. Knowledge transfer and expatriation in multinational corporations

    DEFF Research Database (Denmark)

    Minbaeva, Dana; Michailova, Snejina

    2004-01-01

    Research on multinational corporation (MNC) knowledge transfer has argued continuously for the behavior of knowledge senders to be a determinant of knowledge transfer. Although the importance of disseminative capacity regarding knowledge transfer has been illustrated in numerous conceptual studies...

  5. Acoustic Multipurpose Cargo Transfer Bag

    Science.gov (United States)

    Baccus, Shelley

    2015-01-01

    The Logistics Reduction (LR) project within the Advanced Exploration Systems (AES) program is tasked with reducing logistical mass and repurposing logistical items. Multipurpose Cargo Transfer Bags (MCTB) are designed to be the same external volume as a regular cargo transfer bag, the common logistics carrier for the International Space Station. After use as a cargo bag, the MCTB can be unzipped and unfolded to be reused. This Acoustic MCTBs transform into acoustic blankets after the initial logistics carrying objective is complete.

  6. Automatic computation of transfer functions

    Science.gov (United States)

    Atcitty, Stanley; Watson, Luke Dale

    2015-04-14

    Technologies pertaining to the automatic computation of transfer functions for a physical system are described herein. The physical system is one of an electrical system, a mechanical system, an electromechanical system, an electrochemical system, or an electromagnetic system. A netlist in the form of a matrix comprises data that is indicative of elements in the physical system, values for the elements in the physical system, and structure of the physical system. Transfer functions for the physical system are computed based upon the netlist.

  7. Debugging Data Transfers in CMS

    CERN Document Server

    Bagliesi, G; Bloom, K; Bockelman, B; Bonacorsi, D; Fisk, I; Flix, J; Hernandez, J; D'Hondt, J; Kadastik, M; Klem, J; Kodolova, O; Kuo, C M; Letts, J; Maes, J; Magini, N; Metson, S; Piedra, J; Pukhaeva, N; Tuura, L; Sonajalg, S; Wu, Y; Van Mulders, P; Villella, I; Wurthwein, F

    2010-01-01

    The CMS experiment at CERN is preparing for LHC data taking in several computing preparation activities. In early 2007 a traffic load generator infrastructure for distributed data transfer tests called the LoadTest was designed and deployed to equip the WLCG sites that support CMS with a means for debugging, load-testing and commissioning data transfer routes among CMS computing centres. The LoadTest is based upon PhEDEx as a reliable, scalable data set replication system. The Debugging Data Transfers (DDT) task force was created to coordinate the debugging of the data transfer links. The task force aimed to commission most crucial transfer routes among CMS sites by designing and enforcing a clear procedure to debug problematic links. Such procedure aimed to move a link from a debugging phase in a separate and independent environment to a production environment when a set of agreed conditions are achieved for that link. The goal was to deliver one by one working transfer routes to the CMS data operations team...

  8. Radiation and combined heat transfer in channels

    International Nuclear Information System (INIS)

    Tamonis, M.

    1986-01-01

    This book presents numerical methods of calculation of radiative and combined heat transfer in channel flows of radiating as well as nonradiating media. Results obtained in calculations for flow conditions of combustion products from organic fuel products are given and methods used in determining the spectral optical properties of molecular gases are analyzed. The book presents applications of heat transfer in solving problems. Topic covered are as follows: optical properties of molecular gases; transfer equations for combined heat transfer; experimental technique; convective heat transfer in heated gas flows; radiative heat transfer in gaseous media; combined heat transfer; and radiative and combined heat transfer in applied problems

  9. Federal Technology Transfer Act Success Stories

    Science.gov (United States)

    Successful Federal Technology Transfer Act (FTTA) partnerships demonstrate the many advantages of technology transfer and collaboration. EPA and partner organizations create valuable and applicable technologies for the marketplace.

  10. Voluntary activation of biceps-to-triceps and deltoid-to-triceps transfers in quadriplegia.

    Science.gov (United States)

    Peterson, Carrie L; Bednar, Michael S; Bryden, Anne M; Keith, Michael W; Perreault, Eric J; Murray, Wendy M

    2017-01-01

    The biceps or the posterior deltoid can be transferred to improve elbow extension function for many individuals with C5 or C6 quadriplegia. Maximum strength after elbow reconstruction is variable; the patient's ability to voluntarily activate the transferred muscle to extend the elbow may contribute to the variability. We compared voluntary activation during maximum isometric elbow extension following biceps transfer (n = 5) and deltoid transfer (n = 6) in three functional postures. Voluntary activation was computed as the elbow extension moment generated during maximum voluntary effort divided by the moment generated with full activation, which was estimated via electrical stimulation. Voluntary activation was on average 96% after biceps transfer and not affected by posture. Individuals with deltoid transfer demonstrated deficits in voluntary activation, which differed by posture (80% in horizontal plane, 69% in overhead reach, and 70% in weight-relief), suggesting inadequate motor re-education after deltoid transfer. Overall, individuals with a biceps transfer better activated their transferred muscle than those with a deltoid transfer. This difference in neural control augmented the greater force-generating capacity of the biceps leading to increased elbow extension strength after biceps transfer (average 9.37 N-m across postures) relative to deltoid transfer (average 2.76 N-m across postures) in our study cohort.

  11. Improving Access to Standardized Fertility Preservation Information for Older Adolescents and Young Adults with Cancer: Using a User-Centered Approach with Young Adult Patients, Survivors, and Partners to Refine Fertility Knowledge Transfer.

    Science.gov (United States)

    Tam, Seline; Puri, Natasha; Stephens, Derek; Mitchell, Laura; Giuliani, Meredith; Papadakos, Janet; Gupta, Abha A

    2016-09-27

    Adolescent and young adult (AYA) cancer patients under 40 should be made aware of their fertility risks and preservation options throughout their care. However, discussions on fertility preservation (FP) do not routinely occur. With a dearth of FP resources, oncology providers may lack knowledge around FP. Thus, informational needs can be unmet, leading to anxiety and distress in patients. Provision of pertinent and timely information can help patients cope better with their diagnosis. FP pamphlets were developed for men and women with cancer. A cross-sectional in-house survey, using convenience sampling, evaluated the pamphlets' effectiveness and measured ease of understanding, acceptability, and perceived utility. Patients and partners were also asked to provide recommendations and complete the Short Test of Functional Health Literacy in Adults (S-TOFHLA) measuring health literacy level. This helps determine if health literacy influences perception of pamphlet effectiveness. All participants (n = 56) reviewed both pamphlets. Fifty-four participants (96 %) found the pamphlet for men useful, while 29 participants (52 %) improved their male fertility knowledge. The pamphlet for women was useful for 52 participants (93 %) and improved knowledge in 35 (63 %) of them. Although the majority of participants had adequate health literacy (98 %), there was insufficient sample diversity to determine if health literacy influenced the pamphlet's effectiveness. Participants indicated preference in receiving verbal (73 %) and written (66 %) information over watching videos or in-class education. They recommended including fertility clinics, financial resources, and statistics in the brochures. These FP pamphlets were concluded as effective in supporting patients in making FP decisions.

  12. Prevention of radiation induced xerostomia by surgical transfer of submandibular salivary gland into the submental space

    International Nuclear Information System (INIS)

    Jha, Naresh; Seikaly, Hadi; Harris, Jeff; Williams, David; Liu, Richard; McGaw, Timothy; Hofmann, Henry; Robinson, Don; Hanson, John; Barnaby, Pam

    2003-01-01

    Background and purpose: Xerostomia is a significant morbidity of radiation treatment in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to the submental space, where it can be shielded from radiation treatment (XRT), would prevent xerostomia. Materials and methods: We conducted a prospective Phase II clinical trial and the patients were followed clinically with salivary flow studies and the University of Washington Quality of Life questionnaire. Results: We report the results on 76 evaluable patients. The salivary gland transfer was done in 60 patients. Nine patients (of 60) did not have postoperative XRT and in eight patients (of 60) the transferred gland was not shielded from XRT due to proximity of disease. The median follow up is 14 months. Of the 43 patients with the salivary gland transfer and post-operative XRT with protection of the transferred gland, 81% have none or minimal xerostomia, and 19% developed moderate to severe xerostomia. Three patients (6.9%) developed local recurrence, five patients (11.6%) developed distant metastases and five patients (11.6%) have died. There were no complications attributed to the surgical procedure. Conclusion: Surgical transfer of a submandibular salivary gland to the submental space preserves its function and prevents the development of radiation induced xerostomia

  13. Status report on radionuclide transfer

    International Nuclear Information System (INIS)

    1980-01-01

    At the suggestion of the Federal Minstry of the Interior, in June 1978, a group of scientists from several institutions who are active in the field of radionuclide transfer or are interested in these problems got together. During the discussions of the work team, especially the transfer soil/plants was emphasized. Then the work team set up a status report on the transfer of the radionuclides relevant in the sense of the radiation protection act. The nuclides H 3 and C14, the isotopes of the Sr, J, and Cs, Tc99, the so-called corrosion nuclides Mn54, Fe59, co-isotopes and Zn65, and isotopes of Pu, Am, and Cm were regarded as important for a possible radiation exposition. Recent investigations revealed that also the natural radionuclides Ra226, Po210, and Pb210 should be covered by the investigations. The goal of this status report is to present the level of knowledge on the transfer of these radionuclides to man in a brief form, giving hints at the most important literature. It was requested by the Federal Ministry of the Interior, as fas as possible, to indicate transfer factors which are necessary for the radio-occology act to be decreed according to Para. 45 of the radiation protection act. Another goal of the report was to show the gap in the knowledge on the radio nuclide transfer. This was thought to help to create a basis for the decisions of the Federal Ministry concerning the support of other investigation projects in the field of transfer of radionuclides. (orig./MG) [de

  14. Young adults’ experiences and satisfaction with the transfer of care.

    NARCIS (Netherlands)

    Staa, A. van; Sattoe, J.N.T.

    2014-01-01

    Purpose: Transition of care of adolescents with chronic conditions is a critical area for clinicians. Patient-reported outcomes may provide important information on the quality of services. This cohort study examines young adults’ experiences and satisfaction with the transfer to adult care and

  15. Debating elective single embryo transfer after in vitro fertilization: a ...

    African Journals Online (AJOL)

    However, despite clinical recommendations and policy statements, patients in clinical practice frequently do request for the transfer of multiple embryos in order to have twins. Such requests conflict with policy guidelines and create an ethical dilemma for physicians: Should the physician do as the couple requests, and there ...

  16. Transfer of surgical competences in the treatment of intersex ...

    African Journals Online (AJOL)

    Transfer of surgical competences in the treatment of intersex disorders in Togo. ... Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on ...

  17. Anterior Transfer of Tibialis Posterior through the Interosseous ...

    African Journals Online (AJOL)

    Postoperative plaster of Paris cast for 6 weeks and ankle foot orthosis were used. We evaluated for correction and ability of the transferred tendon to actively dorsiflex at the ankle joint. Nineteen patients had good results 8 fair and 3 poor there was no neurovascular deficit. The purpose of this paper is to outline our outcome ...

  18. Transfer matrix method for four-flux radiative transfer.

    Science.gov (United States)

    Slovick, Brian; Flom, Zachary; Zipp, Lucas; Krishnamurthy, Srini

    2017-07-20

    We develop a transfer matrix method for four-flux radiative transfer, which is ideally suited for studying transport through multiple scattering layers. The model predicts the specular and diffuse reflection and transmission of multilayer composite films, including interface reflections, for diffuse or collimated incidence. For spherical particles in the diffusion approximation, we derive closed-form expressions for the matrix coefficients and show remarkable agreement with numerical Monte Carlo simulations for a range of absorption values and film thicknesses, and for an example multilayer slab.

  19. Wireless power transfer: control algorithm to transfer the maximum power

    OpenAIRE

    Rojas Urbano, Javier Arturo

    2016-01-01

    This job is developed as part of “Health aware enhanced range wireless power transfer systems", known as ETHER. It is a cooperation project where Universidad Politécnica de Madrid (UPM) and Universidad Politécnica de Cataluña (UPC) research groups are mainly involved. ETHER objective is to develop a wireless power transfer system for medical applications, specifically a pacemaker charger to improve patient’s lifestyle decreasing the number of required operations to replace pacemaker batter...

  20. CANISTER TRANSFER SYSTEM DESCRIPTION DOCUMENT

    International Nuclear Information System (INIS)

    B. Gorpani

    2000-01-01

    The Canister Transfer System receives transportation casks containing large and small disposable canisters, unloads the canisters from the casks, stores the canisters as required, loads them into disposal containers (DCs), and prepares the empty casks for re-shipment. Cask unloading begins with cask inspection, sampling, and lid bolt removal operations. The cask lids are removed and the canisters are unloaded. Small canisters are loaded directly into a DC, or are stored until enough canisters are available to fill a DC. Large canisters are loaded directly into a DC. Transportation casks and related components are decontaminated as required, and empty casks are prepared for re-shipment. One independent, remotely operated canister transfer line is provided in the Waste Handling Building System. The canister transfer line consists of a Cask Transport System, Cask Preparation System, Canister Handling System, Disposal Container Transport System, an off-normal canister handling cell with a transfer tunnel connecting the two cells, and Control and Tracking System. The Canister Transfer System operating sequence begins with moving transportation casks to the cask preparation area with the Cask Transport System. The Cask Preparation System prepares the cask for unloading and consists of cask preparation manipulator, cask inspection and sampling equipment, and decontamination equipment. The Canister Handling System unloads the canister(s) and places them into a DC. Handling equipment consists of a bridge crane hoist,; DC--loading manipulator, lifting fixtures, and small canister staging racks. Once the cask has been unloaded, the Cask Preparation System decontaminates the cask exterior and returns it to the Carrier/Cask Handling System via the Cask Transport System. After the; DC--is fully loaded, the Disposal Container Transport System moves the; DC--to the Disposal Container Handling System for welding. To handle off-normal canisters, a separate off-normal canister

  1. Canister Transfer System Description Document

    International Nuclear Information System (INIS)

    2000-01-01

    The Canister Transfer System receives transportation casks containing large and small disposable canisters, unloads the canisters from the casks, stores the canisters as required, loads them into disposal containers (DCs), and prepares the empty casks for re-shipment. Cask unloading begins with cask inspection, sampling, and lid bolt removal operations. The cask lids are removed and the canisters are unloaded. Small canisters are loaded directly into a DC, or are stored until enough canisters are available to fill a DC. Large canisters are loaded directly into a DC. Transportation casks and related components are decontaminated as required, and empty casks are prepared for re-shipment. One independent, remotely operated canister transfer line is provided in the Waste Handling Building System. The canister transfer line consists of a Cask Transport System, Cask Preparation System, Canister Handling System, Disposal Container Transport System, an off-normal canister handling cell with a transfer tunnel connecting the two cells, and Control and Tracking System. The Canister Transfer System operating sequence begins with moving transportation casks to the cask preparation area with the Cask Transport System. The Cask Preparation System prepares the cask for unloading and consists of cask preparation manipulator, cask inspection and sampling equipment, and decontamination equipment. The Canister Handling System unloads the canister(s) and places them into a DC. Handling equipment consists of a bridge crane/hoist, DC loading manipulator, lifting fixtures, and small canister staging racks. Once the cask has been unloaded, the Cask Preparation System decontaminates the cask exterior and returns it to the Carrier/Cask Handling System via the Cask Transport System. After the DC is fully loaded, the Disposal Container Transport System moves the DC to the Disposal Container Handling System for welding. To handle off-normal canisters, a separate off-normal canister handling

  2. Radioactivity transfer to animal products

    International Nuclear Information System (INIS)

    Coughtrey, P.J.

    1990-01-01

    Information on the behaviour of strontium, caesium, ruthenium, plutonium and americium in a range of domestic animals is reviewed to form a basis for the specification of time-dependent mathematical models describing uptake, distribution and retention in various domestic animals. Transfer factors relating concentration in animal product to daily radioactivity intake are derived after 100 d continuous intake and at equilibrium. These transfer factors are compared with the available published literature and used as a basis for the derivation of feedingstuff conversion factors relating limiting concentrations in animal feedingstuffs to limiting concentrations in human foodstuffs for application to animals receiving commercial feedingstuffs after a nuclear accident. Recommended transfer factors for animal products in conditions of continuous discharge and models for application to field conditions after a nuclear accident are also presented. Transfer of caesium to animal products is more effective than that for the other elements considered here. Transfer to meat of lamb, fattening pig, and chickens is generally more effective than that for other animals and other products

  3. Delaminated Transfer of CVD Graphene

    Science.gov (United States)

    Clavijo, Alexis; Mao, Jinhai; Tilak, Nikhil; Altvater, Michael; Andrei, Eva

    Single layer graphene is commonly synthesized by dissociation of a carbonaceous gas at high temperatures in the presence of a metallic catalyst in a process known as Chemical Vapor Deposition or CVD. Although it is possible to achieve high quality graphene by CVD, the standard transfer technique of etching away the metallic catalyst is wasteful and jeopardizes the quality of the graphene film by contamination from etchants. Thus, development of a clean transfer technique and preservation of the parent substrate remain prominent hurdles to overcome. In this study, we employ a copper pretreatment technique and optimized parameters for growth of high quality single layer graphene at atmospheric pressure. We address the transfer challenge by utilizing the adhesive properties between a polymer film and graphene to achieve etchant-free transfer of graphene films from a copper substrate. Based on this concept we developed a technique for dry delamination and transferring of graphene to hexagonal boron nitride substrates, which produced high quality graphene films while at the same time preserving the integrity of the copper catalyst for reuse. DOE-FG02-99ER45742, Ronald E. McNair Postbaccalaureate Achievement Program.

  4. Nuclear fuel powder transfer device

    International Nuclear Information System (INIS)

    Komono, Akira

    1998-01-01

    A pair of parallel rails are laid between a receiving portion to a molding portion of a nuclear fuel powder transfer device. The rails are disposed to the upper portion of a plurality of parallel support columns at the same height. A powder container is disposed while being tilted in the inside of the vessel main body of a transfer device, and rotational shafts equipped with wheels are secured to right and left external walls. A nuclear powder to be mixed, together with additives, is supplied to the powder container of the transfer device. The transfer device engaged with the rails on the receiving side is transferred toward the molding portion. The wheels are rotated along the rails, and the rotational shafts, the vessel main body and the powder container are rotated. The nuclear powder in the tilted powder container disposed is rotated right and left and up and down by the rotation, and the powder is mixed satisfactory when it reaches the molding portion. (I.N.)

  5. Transfer pricing and safe harbours

    Directory of Open Access Journals (Sweden)

    Veronika Solilová

    2013-01-01

    Full Text Available Transfer prices are significant for both taxpayers and tax administrations because they determine in large part taxable profits of associated enterprises in different tax jurisdictions. Moreover, in the context of taxation, transfer prices must be complied with the arm’s length principle. However, Multinational Enterprises have been faced daily by conflicting rules and approaches to applying the arm’s length principle, burdensome documentation requirements, inconsistent audit standards and unpredictable competent authority outcomes. Therefore, the Committee on Fiscal Affairs launched another project on the administrative aspects of transfer pricing in 2010. On 16 May 2013 as a partial solution of this project was approved by the OECD Council the Revised Section E on Safe Harbours in Chapter IV of the Transfer Pricing Guidelines for Multinational Enterprises and Tax Authorities. The paper is focused on significant changes of newly approved chapter IV of the Transfer Pricing Guidelines for Multinational Enterprises and Tax Authorities, further on analysis of practice in this area, on advantages and disadvantages of safe harbours for taxpayers and competent authorities with aim to suggest recommendations on use of safe harbours in the Czech Republic.

  6. MRS transfer facility feasibility study

    International Nuclear Information System (INIS)

    Jowdy, A.K.; Smith, R.I.

    1990-12-01

    Under contract to the US Department of Energy, Parsons was requested to evaluate the feasibility of building a simple hot cell (waste handling) transfer facility at the Monitored Retrievable Storage (MRS) site to facilitate acceptance of spent fuel into the Federal Waste Management System starting in early 1998. The Transfer Facility was intended to provide a receiving and transfer to storage capability at a relatively low throughput rate (approximately 500 MTU/yr) and to provide the recovery capability needed on the site in the event of a transport or storage cask seal failure during a period of about two years while the larger Spent Fuel Handling Building (SFHB) was being completed. Although the original study basis postulated an incremental addition to the larger, previously considered MRS configurations, study results show that the Transfer Facility may be capable of receiving and storing spent fuel at annual rates of 3000 MTU/yr or more, making a larger fuel handling structure unnecessary. In addition, the study analyses showed that the Transfer Facility could be constructed and put into service in 15--17 months and would cost less than the previous configurations. 2 figs., 2 tabs

  7. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol

    Directory of Open Access Journals (Sweden)

    Amélie Perrin

    2017-09-01

    Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization

  8. [Transfer managment of postoperative acute pain therapy to outpatient aftercare].

    Science.gov (United States)

    Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

    2014-10-01

    The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Data capture and communication during transfers to definitive care in an inclusive trauma system.

    Science.gov (United States)

    Bradley, Nori L; Garraway, Naisan; Bell, Nathaniel; Lakha, Nasira; Hameed, S Morad

    2017-05-01

    Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243). Completion rates of paramedic form and ATLS primary survey variables were extracted. Nominal and interval descriptives were calculated. Documentation rates were considered deficient at system-wide information transfer. Copyright © 2016. Published by Elsevier Ltd.

  10. Reverse Knowledge Transfer in MNEs

    DEFF Research Database (Denmark)

    Mudambi, Ram; Piscitello, Lucia; Rabbiosi, Larissa

    2014-01-01

    a positive correlation with the extent of reverse knowledge transfers to the parent MNE. Relying on the headquarters-subsidiary view of the MNE, we argue that, beyond a point, increasing subsidiary innovativeness will be associated with lower reverse knowledge transfers. Further, we argue......It is now well recognized that multinational enterprises (MNEs) are differentiated networks wherein subsidiaries vary in terms of their ability to create new knowledge and competencies for their parent groups. In much of this theory, it is taken for granted that subsidiary innovativeness has...... that this relationship is sensitive to the subsidiary entry mode. Using data from a sample of 293 Italian subsidiaries, we find strong support for our hypotheses. In particular, our results confirm that the effect of subsidiary innovativeness on reverse knowledge transfers displays an inverted-U shape...

  11. TRANSFER PRICES IN ROMANIAN ECONOMY

    Directory of Open Access Journals (Sweden)

    ANDREEA-LAVINIA CAZACU (NEAMTU

    2016-10-01

    Full Text Available Transfer prices are a delicate subject and of major importance in jurisdictions to which they belong, as they are often used as a means of exploiting tax legislation. In proceedings of tax inspection and financial control carried out by the tax authorities, a special place is occupied by the transactions between affiliated entities with Romanian companies. The purpose of the tax inspection is: combating tax evasion and tracking these transactions to be carried out at market prices. The article aims to present how transfer prices affect the value of an enterprise, but also the methodological aspects relating to tax inspection and the necessary documents in order to deciphering the mode of transfer pricing in Romania.

  12. Some Metapsychological Considerations about Transference

    Directory of Open Access Journals (Sweden)

    Sergio Guillermo Castellanos-Urrego**

    2009-12-01

    Full Text Available This paper shows a metapsychological re-creation of transference from a conceptualization of representations as the units of psychism. Transferences have their origins in the effort of an unsatisfied libidinal investiture that continues to be active in the Unconscious, and which allows the primary process to inadvertently filter into the secondary process through a “false link”. Therefore, a current perception becomes identified with the expectative representation, which makes the individual believe that this new person will satisfy the aforementioned investiture. Transference neurosis is a psychoanalytic pillar, since only through it may one consciously and currently have access the repressed unconscious drives, a feature of childhood sexuality, and restart the psychosexual development.

  13. SERPUKHOV: UNK transfer beamline commissioned

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    At the end of the 1000 hour February-March run of the 70 GeV proton synchrotron at the Institute for High Energy Physics (IHEP), Serpukhov, near Moscow, the new 2.7-kilometre UNK Beam Transfer Line (BTL) was commissioned with proton beam. BTL will eventually transfer beam from the existing U70 proton accelerator to the first stage of the UNK (UNK-1, now under construction) where it will be accelerated in the 21- kilometre ring up to 600 GeV. BTL was designed for proton energies between 60 and 70 GeV, momentum spread ± 2 x 10 -3 and beam emittance 2 mm.mrad, with systems for fast ejection, beam transfer and injection into UNK-1

  14. Heat transfer from rough surfaces

    International Nuclear Information System (INIS)

    Dalle Donne, M.

    1977-01-01

    Artificial roughness is often used in nuclear reactors to improve the thermal performance of the fuel elements. Although these are made up of clusters of rods, the experiments to measure the heat transfer and friction coefficients of roughness are performed with single rods contained in smooth tubes. This work illustrated a new transformation method to obtain data applicable to reactor fuel elements from these annulus experiments. New experimental friction data are presented for ten rods, each with a different artificial roughness made up of two-dimensional rectangular ribs. For each rod four tests have been performed, each in a different outer smooth tube. For two of these rods, each for two different outer tubes, heat transfer data are also given. The friction and heat transfer data, transformed with the present method, are correlated by simple equations. In the paper, these equations are applied to a case typical for a Gas Cooled Fast Reactor fuel element. (orig.) [de

  15. Heat Transfer Basics and Practice

    CERN Document Server

    Böckh, Peter

    2012-01-01

    The book provides an easy way to understand the fundamentals of heat transfer. The reader will acquire the ability to design and analyze heat exchangers. Without extensive derivation of the fundamentals, the latest correlations for heat transfer coefficients and their application are discussed. The following topics are presented - Steady state and transient heat conduction - Free and forced convection - Finned surfaces - Condensation and boiling - Radiation - Heat exchanger design - Problem-solving After introducing the basic terminology, the reader is made familiar with the different mechanisms of heat transfer. Their practical application is demonstrated in examples, which are available in the Internet as MathCad files for further use. Tables of material properties and formulas for their use in programs are included in the appendix. This book will serve as a valuable resource for both students and engineers in the industry. The author’s experience indicates that students, after 40 lectures and exercises ...

  16. Essentials of radiation heat transfer

    CERN Document Server

    Balaji

    2014-01-01

    Essentials of Radiation Heat Transfer is a textbook presenting the essential, fundamental information required to gain an understanding of radiation heat transfer and equips the reader with enough knowledge to be able to tackle more challenging problems. All concepts are reinforced by carefully chosen and fully worked examples, and exercise problems are provided at the end of every chapter. In a significant departure from other books on this subject, this book completely dispenses with the network method to solve problems of radiation heat transfer in surfaces. It instead presents the powerful radiosity-irradiation method and shows how this technique can be used to solve problems of radiation in enclosures made of one to any number of surfaces. The network method is not easily scalable. Secondly, the book introduces atmospheric radiation, which is now being considered as a potentially important area, in which engineers can contribute to the technology of remote sensing and atmospheric sciences in general, b...

  17. Preferred design of transfer points

    Energy Technology Data Exchange (ETDEWEB)

    Firstbrook, J

    1983-06-01

    The paper reports the results of a study carried out at MRDE on the performance of transfer points. These sites still require a considerable deployment of manpower. The investigations were divided into 3 main sections: mineral handling; chute design; belt cleaning and spillage conveying. In order to achieve a sufficient level of reliability of a transfer system, it is considered that the coal size should not be greater than 250 mm. Different designs of gravity transfer chute were studied and 3 basic designs emerged as being effective : dump chute, curved site entry, and asymmetric side entry. Selection is dependent on conveyor sizes, speeds, and mineral throughput. Individual belt cleaners are not sufficient to clean belts carrying typical run-of-mine material: two cleaners followed by a set of squeeze rollers are recommended. Several designs of spillage conveyor were investigated; at the present time the electro/hydraulic type appears to be the most satisfactory.

  18. Computer Independent Data Transfer Device

    Directory of Open Access Journals (Sweden)

    Darshana Rarath

    2017-07-01

    Full Text Available In today’s era, transferring data among distinct storage devices has become one of the tasks which are done most frequently. In order to make data and information omnipresent, it needs to be shared anywhere and anytime. However the reliance of user on a PC or laptop for the same is not efficient. This paper is about the innovative way to overcome this restriction. This paper discusses the development of a portable device with the use of wired and wireless communication applications to share data and information among distinct storage devices without relying on a PC or a laptop. The proposed device is compact, comprises of a touch screen, power source and is capable of transferring all types of files. Hence, it eliminates the dependence on a PC or a laptop for transferring data.

  19. Ceramics for Molten Materials Transfer

    Science.gov (United States)

    Standish, Evan; Stefanescu, Doru M.; Curreri, Peter A.

    2009-01-01

    The paper reviews the main issues associated with molten materials transfer and handling on the lunar surface during the operation of a hig h temperature electrowinning cell used to produce oxygen, with molten iron and silicon as byproducts. A combination of existing technolog ies and purposely designed technologies show promise for lunar exploi tation. An important limitation that requires extensive investigation is the performance of refractory currently used for the purpose of m olten metal containment and transfer in the lunar environment associa ted with electrolytic cells. The principles of a laboratory scale uni t at a scale equivalent to the production of 1 metric ton of oxygen p er year are introduced. This implies a mass of molten materials to be transferred consistent with the equivalent of 1kg regolithlhr proces sed.

  20. Technology transfer - north/south

    Energy Technology Data Exchange (ETDEWEB)

    Ercan, Y [Gazi University, Ankara (Turkey). Faculty of Engineering and Architecture

    1991-01-01

    Technology transfer is needed to the developing countries in the fields of fuel, combustion equipment, and operations to maximise combustion efficiency and minimise the harmful emissions. Channels of technology transfer available include: direct foreign investment, joint ventures, patent and licence purchases, industrial co-operation and technical aid, importation of technical goods, and turn-key projects. Dependency on totally imported technology and equipment both in boilers and flue gas treatment systems, however, results in high investment costs and may limit extensive use of power plants based on coal. If technologies to improve the efficiencies and emission behaviour of coal utilizing facilities are transferred to developing countries, a business scheme mutually beneficial both to the developing countries and the coal producing countries can be reached, which will boost the industrialization of the developing countries. 11 refs., 3 figs., 1 tab.